Healthcare Provider Details

I. General information

NPI: 1447183611
Provider Name (Legal Business Name): EZGI PEHLIVAN PA-C
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 NJ-36 BUILDING C
WEST LONG BRANCH NJ
07764
US

IV. Provider business mailing address

185 NJ-36 BUILDING C
WEST LONG BRANCH NJ
07764
US

V. Phone/Fax

Practice location:
  • Phone: 732-923-4505
  • Fax:
Mailing address:
  • Phone: 732-923-4505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: