Provider Demographics
NPI:1215369772
Name:PHADNIS, AMRITA A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMRITA
Middle Name:A
Last Name:PHADNIS
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 1:9 GLORIA LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-0168
Mailing Address - Country:US
Mailing Address - Phone:507-358-1932
Mailing Address - Fax:
Practice Address - Street 1:113 SOUTH ROUTE 73
Practice Address - Street 2:POWERBACK VOORHEES
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-809-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00137800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant