Provider Demographics
NPI:1407052764
Name:HARTMAN, ALISJA L (PA)
Entity Type:Individual
Prefix:
First Name:ALISJA
Middle Name:L
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALISJA
Other - Middle Name:L
Other - Last Name:STENGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:J2 BRIER HILL CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3340
Mailing Address - Country:US
Mailing Address - Phone:732-390-7750
Mailing Address - Fax:732-390-4628
Practice Address - Street 1:J2 BRIER HILL CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3340
Practice Address - Country:US
Practice Address - Phone:732-390-7750
Practice Address - Fax:732-390-4628
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00148900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223141761OtherRCCA TAX ID#
NJ25MP00148900OtherLICENSE
NJ5426600Medicaid
NJ699873OtherRCCA GROUP MEDICARE #
NJ1801850243OtherRCCA GROUP NPI#