Healthcare Provider Details

I. General information

NPI: 1376355339
Provider Name (Legal Business Name): PANAGIOTA TSETSAKOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 STATE ROUTE 33 STE 4B
NEPTUNE NJ
07753-4860
US

IV. Provider business mailing address

1820 STATE ROUTE 33 STE 4B
NEPTUNE NJ
07753-4860
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-8500
  • Fax:
Mailing address:
  • Phone: 732-776-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: