Healthcare Provider Details

I. General information

NPI: 1558844159
Provider Name (Legal Business Name): JANA MARIE HURTA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 AMSTERDAM AVE
NEW YORK NY
10025-1716
US

IV. Provider business mailing address

118 FAIRVIEW AVE
LONG VALLEY NJ
07853-3173
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-4000
  • Fax:
Mailing address:
  • Phone: 908-303-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number022559
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: