Provider Demographics
NPI:1982326617
Name:GIRARD, ADRIANA (PA-C)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:GIRARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BUTTERNUTT CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-1814
Mailing Address - Country:US
Mailing Address - Phone:201-819-2509
Mailing Address - Fax:
Practice Address - Street 1:71 UNION AVE STE 108
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1272
Practice Address - Country:US
Practice Address - Phone:201-804-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NJ25MP00708500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant