Provider Demographics
NPI:1003420050
Name:SALVADOR, ISABELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:ISABELLE
Middle Name:
Last Name:SALVADOR
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 1:524 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-2310
Mailing Address - Country:US
Mailing Address - Phone:201-375-1429
Mailing Address - Fax:
Practice Address - Street 1:5 SUMMIT AVE STE 105
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1271
Practice Address - Country:US
Practice Address - Phone:551-996-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00574000363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical