Healthcare Provider Details

I. General information

NPI: 1922702364
Provider Name (Legal Business Name): ALYSSA KWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 STONE ST
RAHWAY NJ
07065-2742
US

IV. Provider business mailing address

3067 SAND STONE CIR
SAINT CLOUD FL
34772-6526
US

V. Phone/Fax

Practice location:
  • Phone: 732-381-4200
  • Fax:
Mailing address:
  • Phone: 407-749-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: