Healthcare Provider Details

I. General information

NPI: 1639008675
Provider Name (Legal Business Name): EILEEN ASHKENAZI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 MAIN ST
RAHWAY NJ
07065-5224
US

IV. Provider business mailing address

1299 MAIN ST
RAHWAY NJ
07065-5224
US

V. Phone/Fax

Practice location:
  • Phone: 732-804-5874
  • Fax: 732-804-5874
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: