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General NPI Number Information
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NPI Number | 1780238535
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Entity Type | Individual
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Provider Name | HELEN FAJARDO PA
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Gender | Female
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 70 HATFIELD LN
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City | GOSHEN
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State | NY
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Zip | 10924-6734
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Country | US
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Telephone | 845-291-3656
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Fax |
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Provider Business Mailing Address
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Address Line | 138 MATTISON RD
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City | BRANCHVILLE
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State | NJ
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Zip | 07826-4006
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Country | US
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Telephone | 973-600-4106
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00528300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 031542
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License Number State | NY
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