Healthcare Provider Details

I. General information

NPI: 1225785900
Provider Name (Legal Business Name): SEBASTIAN PAWEL OPAR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 US HIGHWAY 22
GREEN BROOK NJ
08812-2147
US

IV. Provider business mailing address

119 US HIGHWAY 22
GREEN BROOK NJ
08812-2147
US

V. Phone/Fax

Practice location:
  • Phone: 732-838-9621
  • Fax:
Mailing address:
  • Phone: 732-293-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00693200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: