Healthcare Provider Details

I. General information

NPI: 1144621962
Provider Name (Legal Business Name): ALEXANDRA JOAN CUMMINGS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA CUMMINGS ONISK PA-C

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 SYCAMORE AVE
SHREWSBURY NJ
07702
US

IV. Provider business mailing address

512 LIPPINCOTT DR
MARLTON NJ
08053-4803
US

V. Phone/Fax

Practice location:
  • Phone: 908-355-8877
  • Fax: 908-355-0017
Mailing address:
  • Phone: 856-797-9161
  • Fax: 856-797-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00346100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00346100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: