Provider Demographics
NPI:1043609910
Name:PIATEK, ALLISON ZAZZALI (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ZAZZALI
Last Name:PIATEK
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 1:131 NJ-70
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:131 NJ-70
Practice Address - Street 2:SUITE 100
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055
Practice Address - Country:US
Practice Address - Phone:856-673-3960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018347363A00000X
NJ25MP00431600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant