Healthcare Provider Details

I. General information

NPI: 1992391288
Provider Name (Legal Business Name): MAYA A ISSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 RT 35 N.
SEASIDE HEIGHTS NJ
08751
US

IV. Provider business mailing address

1600 RT 35 N.
SEASIDE HEIGHTS NJ
08751
US

V. Phone/Fax

Practice location:
  • Phone: 732-793-2890
  • Fax: 732-793-2911
Mailing address:
  • Phone: 732-793-2890
  • Fax: 732-793-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02992100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: