=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528883535
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANNA EMILE PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2024
-----------------------------------------------------
Last Update Date | 11/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 WATSON AVE
-----------------------------------------------------
City | EAST ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07018-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-250-1947
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60 WATSON AVE
-----------------------------------------------------
City | EAST ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07018-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | 25MP00897100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------