Healthcare Provider Details

I. General information

NPI: 1114256583
Provider Name (Legal Business Name): CHRISTINA TERESA AZOIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WILLIAMSON ST
ELIZABETH NJ
07202-3625
US

IV. Provider business mailing address

15 LOESER AVE
CLARK NJ
07066-2523
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-5000
  • Fax:
Mailing address:
  • Phone: 732-499-7387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00230000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00230000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00230000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: