=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215287602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PEDER AAKJAR
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2012
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 852 ROUTE 3
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07012-2343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-450-1991
-----------------------------------------------------
Fax | 973-528-8009
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 DIAMOND HILL RD
-----------------------------------------------------
City | BERKELEY HEIGHTS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07922-2104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-273-4300
-----------------------------------------------------
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 | 25MP00627600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | 015909
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------