MEDICARE: EMMANUEL KISSI PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	011915-1	NY
2	363AM0700X	Medical Physician Assistant	25MP00192500	NJ

General Provider Information

NPI Number	:	1568658136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUEL KISSI PA

Provider Business Mailing Address
First Line	:	328 W SAINT GEORGES AVE
Second Line	:
City	:	LINDEN
State	:	NJ
Zip	:	07036-5638
Country	:	US
Telephone Number	:	908-925-7519
Fax Number	:	908-925-2842

Provider Business Practice Location Address
First Line	:	1881 RARITAN RD
Second Line	:
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-2929
Country	:	US
Telephone Number	:	908-494-1175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	04/17/2026

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Directions to “ EMMANUEL KISSI PA” Practice Location

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