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NPI Code Detail

MEDICARE: CHRISTIAN JOSEPH LOGAN PA-C

MEDICARE: CHRISTIAN JOSEPH LOGAN PA-C
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
1363AM0700XMedical Physician Assistant25MP00858500NJ

General Provider Information

NPI Number : 1720823214
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTIAN JOSEPH LOGAN PA-C
Provider Business Mailing Address
First Line : 331 NEWMAN SPRINGS RD STE 220
Second Line :
City : RED BANK
State : NJ
Zip : 07701-5792
Country : US
Telephone Number : 732-807-0877
Fax Number : 201-751-1680
Provider Business Practice Location Address
First Line : 65 JAMES ST
Second Line :
City : EDISON
State : NJ
Zip : 08820-3947
Country : US
Telephone Number : 732-321-7000
Fax Number : 732-744-5969
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2024
Last Update Date : 05/05/2026

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Directions to “ CHRISTIAN JOSEPH LOGAN PA-C” Practice Location

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