Healthcare Provider Details

I. General information

NPI: 1427113265
Provider Name (Legal Business Name): SALLY M HUR PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SALLY M HUR SHAFFER PAC

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADISON AVE # GAGNONC
MORRISTOWN NJ
07960-6136
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-7300
  • Fax: 973-984-7019
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMP00105200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP001052
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00105200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: