Healthcare Provider Details

I. General information

NPI: 1811329964
Provider Name (Legal Business Name): NATHALIE VIGNIER PA-C, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 WILLOW AVE
HOBOKEN NJ
07030-3808
US

IV. Provider business mailing address

125 GREAVES LN
STATEN ISLAND NY
10308-2175
US

V. Phone/Fax

Practice location:
  • Phone: 201-418-1000
  • Fax:
Mailing address:
  • Phone: 718-502-8763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00352808
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number016720-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: