Healthcare Provider Details

I. General information

NPI: 1194829796
Provider Name (Legal Business Name): SANDRA DOOLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD
LYONS NJ
07939-5001
US

IV. Provider business mailing address

236 W LOCUST AVE
EDISON NJ
08820-1214
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax: 908-604-5266
Mailing address:
  • Phone: 732-381-3593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00003200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: