Healthcare Provider Details

I. General information

NPI: 1437756350
Provider Name (Legal Business Name): OLIVIA N DUDLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2020
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PARK AVE
FLORHAM PARK NJ
07932-1049
US

IV. Provider business mailing address

140 PARK AVE
FLORHAM PARK NJ
07932-1049
US

V. Phone/Fax

Practice location:
  • Phone: 973-404-9800
  • Fax: 973-267-1737
Mailing address:
  • Phone: 973-404-9800
  • Fax: 973-267-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00582100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00582100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: