Provider Demographics
NPI:1083170005
Name:GAON, AYELET ESTHER
Entity Type:Individual
Prefix:
First Name:AYELET
Middle Name:ESTHER
Last Name:GAON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AYELET
Other - Middle Name:
Other - Last Name:GAON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:328 TERHUNE AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3350
Mailing Address - Country:US
Mailing Address - Phone:973-722-0456
Mailing Address - Fax:
Practice Address - Street 1:852 ROUTE 3
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2343
Practice Address - Country:US
Practice Address - Phone:973-450-1991
Practice Address - Fax:973-528-8009
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty