Provider Demographics
NPI:1467056507
Name:DASTIS, MADISON (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MADISON
Middle Name:
Last Name:DASTIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:137 CONOVER TER
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-2184
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2042 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6045
Practice Address - Country:US
Practice Address - Phone:908-350-4444
Practice Address - Fax:908-360-0490
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant