Provider Demographics
NPI:1023395902
Name:EGUEZ, LORENA M (PA)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:M
Last Name:EGUEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 GRAND COVE WAY
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-7222
Mailing Address - Country:US
Mailing Address - Phone:201-422-0313
Mailing Address - Fax:
Practice Address - Street 1:1829 HUDSON PARK
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1575
Practice Address - Country:US
Practice Address - Phone:201-562-5523
Practice Address - Fax:563-649-6013
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00265300363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant