Healthcare Provider Details

I. General information

NPI: 1578282075
Provider Name (Legal Business Name): MARY CAROLINE AUSTIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CENTRAL AVE STE 500
NEW PROVIDENCE NJ
07974-1505
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 908-795-1194
  • Fax: 908-522-5999
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00956400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: