Healthcare Provider Details

I. General information

NPI: 1730065509
Provider Name (Legal Business Name): ERIN DOHERTY WELSH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 907
HACKENSACK NJ
07601-1989
US

IV. Provider business mailing address

301 KETTLE CREEK RD
TOMS RIVER NJ
08753-1947
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-2550
  • Fax: 201-342-7171
Mailing address:
  • Phone: 814-404-8729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00951500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: