Healthcare Provider Details

I. General information

NPI: 1902720501
Provider Name (Legal Business Name): ELIZABETH SUSANA ISAULA-MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 JOHN F. KENNEDY BLVD SUITE 1W
NORTH BERGEN NJ
07047
US

IV. Provider business mailing address

8901 JOHN F. KENNEDY BLVD SUITE 1W
NORTH BERGEN NJ
07047
US

V. Phone/Fax

Practice location:
  • Phone: 201-430-2022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP01033000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: