Healthcare Provider Details

I. General information

NPI: 1457827354
Provider Name (Legal Business Name): GRETCHEN AMRIEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BYPASS RD STE 201
SALEM NJ
08079-2053
US

IV. Provider business mailing address

4 BYPASS RD STE 201
SALEM NJ
08079-2053
US

V. Phone/Fax

Practice location:
  • Phone: 856-935-0066
  • Fax:
Mailing address:
  • Phone: 856-935-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00506300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: