Healthcare Provider Details

I. General information

NPI: 1003591850
Provider Name (Legal Business Name): ARIETA KRAJA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 N RTE 17
PARAMUS NJ
07652-3001
US

IV. Provider business mailing address

7 REMSEN ST
STATEN ISLAND NY
10304-4117
US

V. Phone/Fax

Practice location:
  • Phone: 551-497-5677
  • Fax: 551-497-5678
Mailing address:
  • Phone: 347-294-6990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00789300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: