Provider Demographics
NPI:1164180139
Name:CHURYLO, KARA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:NICOLE
Last Name:CHURYLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 US HWY 202
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822
Mailing Address - Country:US
Mailing Address - Phone:908-788-8200
Mailing Address - Fax:908-788-8207
Practice Address - Street 1:505 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-1918
Practice Address - Country:US
Practice Address - Phone:908-241-0200
Practice Address - Fax:908-241-0445
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00667000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant