Healthcare Provider Details

I. General information

NPI: 1275589814
Provider Name (Legal Business Name): TANIA UWAIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STATE ROUTE 33 STE 15
NEPTUNE NJ
07753-6116
US

IV. Provider business mailing address

2100 STATE ROUTE 33 STE 15
NEPTUNE NJ
07753-6116
US

V. Phone/Fax

Practice location:
  • Phone: 732-988-8228
  • Fax: 732-774-1528
Mailing address:
  • Phone: 732-988-8228
  • Fax: 732-774-1528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00094200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: