Healthcare Provider Details

I. General information

NPI: 1598012429
Provider Name (Legal Business Name): PHYSIOLOGIC ASSESSMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 WOOD AVE S STE 600
ISELIN NJ
08830-2717
US

IV. Provider business mailing address

PO BOX 28419
NEW YORK NY
10087-8419
US

V. Phone/Fax

Practice location:
  • Phone: 484-351-8459
  • Fax: 484-351-8810
Mailing address:
  • Phone: 484-351-8459
  • Fax: 484-351-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY FRYE
Title or Position: CFO
Credential:
Phone: 484-351-8459