Healthcare Provider Details

I. General information

NPI: 1588702336
Provider Name (Legal Business Name): ANDREA CHRISTINE CONAWAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BRUNSWICK AVE
TRENTON NJ
08638-4143
US

IV. Provider business mailing address

PO BOX 8500-1611
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 609-394-6013
  • Fax: 609-815-7529
Mailing address:
  • Phone: 609-396-2600
  • Fax: 609-396-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00053100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: