Healthcare Provider Details

I. General information

NPI: 1225969793
Provider Name (Legal Business Name): PATRICIA SARA BLAZON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN ST
PATERSON NJ
07503-2621
US

IV. Provider business mailing address

25 PLEASANT VIEW TER
WALLINGTON NJ
07057-2016
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-2000
  • Fax:
Mailing address:
  • Phone: 201-705-4330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP01032800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP01032800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: