Provider Demographics
NPI:1235136318
Name:BOYANOVSKI, ALLISON (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:BOYANOVSKI
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 WAYNE ST
Mailing Address - Street 2:324D
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-5407
Mailing Address - Country:US
Mailing Address - Phone:732-925-6431
Mailing Address - Fax:732-225-4551
Practice Address - Street 1:355 GRAND ST
Practice Address - Street 2:SURGERY DEPARTMENT
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4321
Practice Address - Country:US
Practice Address - Phone:201-915-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP000798363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ056372AQVMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER