Healthcare Provider Details

I. General information

NPI: 1447167697
Provider Name (Legal Business Name): SAMIA KHONDAKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 WALTER E FORAN BLVD STE 4000
FLEMINGTON NJ
08822-4675
US

IV. Provider business mailing address

214 PEACH TREE LN
EGG HARBOR TOWNSHIP NJ
08234-5257
US

V. Phone/Fax

Practice location:
  • Phone: 609-289-3147
  • Fax:
Mailing address:
  • Phone: 609-289-3147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP01046200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: