=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003591850
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARIETA KRAJA PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2023
-----------------------------------------------------
Last Update Date | 09/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 499 N RTE 17
-----------------------------------------------------
City | PARAMUS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07652-3001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-497-5677
-----------------------------------------------------
Fax | 551-497-5678
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 REMSEN ST
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10304-4117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-294-6990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 25MP00789300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------