Healthcare Provider Details

I. General information

NPI: 1316583412
Provider Name (Legal Business Name): KAYVON AMERI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2019
Last Update Date: 11/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 LAFAYETTE RD STE 202
SPARTA NJ
07871-3560
US

IV. Provider business mailing address

286 4TH ST APT 2
NEWARK NJ
07107-3213
US

V. Phone/Fax

Practice location:
  • Phone: 908-684-2480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00540900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: