Healthcare Provider Details

I. General information

NPI: 1508911207
Provider Name (Legal Business Name): KAREN L DITTMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149M HIGHWAY 31
FLEMINGTON NJ
08822
US

IV. Provider business mailing address

59 ROUTE 22
CLINTON NJ
08809-1342
US

V. Phone/Fax

Practice location:
  • Phone: 908-782-7700
  • Fax: 908-782-3644
Mailing address:
  • Phone: 908-730-6363
  • Fax: 908-730-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00040400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: