MEDICARE: GRACE CATENA 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
1	363A00000X	Physician Assistant	25MP00583200	NJ

General Provider Information

NPI Number	:	1861099277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE CATENA PA-C

Provider Business Mailing Address
First Line	:	317 WATSON AVE
Second Line	:
City	:	LYNDHURST
State	:	NJ
Zip	:	07071-2111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 UNION AVE STE 108
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-1272
Country	:	US
Telephone Number	:	201-804-8900
Fax Number	:

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

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	04/26/2023

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Directions to “ GRACE CATENA PA-C” Practice Location

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