Healthcare Provider Details

I. General information

NPI: 1184336125
Provider Name (Legal Business Name): SIANI SNAITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 MCCARTER HWY
NEWARK NJ
07114-2562
US

IV. Provider business mailing address

375 MCCARTER HWY
NEWARK NJ
07114-2562
US

V. Phone/Fax

Practice location:
  • Phone: 973-643-8601
  • Fax:
Mailing address:
  • Phone: 973-643-8601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: