Healthcare Provider Details

I. General information

NPI: 1912315169
Provider Name (Legal Business Name): ELIZABETH DAVISON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 JAMES ST STE 150
FLORHAM PARK NJ
07932-1426
US

IV. Provider business mailing address

10 JAMES ST
FLORHAM PARK NJ
07932-1426
US

V. Phone/Fax

Practice location:
  • Phone: 973-822-2000
  • Fax: 973-822-2001
Mailing address:
  • Phone: 973-822-2000
  • Fax: 973-822-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00342100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: