Healthcare Provider Details

I. General information

NPI: 1235506205
Provider Name (Legal Business Name): ASHA CILLY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PATERSON ST SUITE 6200
NEW BRUNSWICK NJ
08901-1962
US

IV. Provider business mailing address

125 PATERSON ST SUITE 6200
NEW BRUNSWICK NJ
08901-1962
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-7342
  • Fax:
Mailing address:
  • Phone: 732-235-7342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00585000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: