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General NPI Number Information
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NPI Number | 1730960881
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Entity Type | Individual
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Provider Name | ANGELIQUE WYGONOWSKI PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 89 SPARTA AVE STE 220
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City | SPARTA
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State | NJ
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Zip | 07871-1793
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Country | US
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Telephone | 973-940-8100
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Fax | 973-729-7235
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Provider Business Mailing Address
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Address Line | PO BOX 416457
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City | BOSTON
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State | MA
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Zip | 02241-3120
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Country | US
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Telephone | 844-362-1735
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Fax | 973-290-7495
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00811200
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License Number State | NJ
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