Healthcare Provider Details

I. General information

NPI: 1568658136
Provider Name (Legal Business Name): EMMANUEL KISSI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 RARITAN RD
SCOTCH PLAINS NJ
07076-2929
US

IV. Provider business mailing address

328 W SAINT GEORGES AVE
LINDEN NJ
07036-5638
US

V. Phone/Fax

Practice location:
  • Phone: 908-494-1175
  • Fax:
Mailing address:
  • Phone: 908-925-7519
  • Fax: 908-925-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number011915-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00192500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: