Provider Demographics
NPI:1487205001
Name:NIERADKA, JUSTYNA (PA-C)
Entity Type:Individual
Prefix:
First Name:JUSTYNA
Middle Name:
Last Name:NIERADKA
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 1:200 SCHLEY ST APT 308
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-2350
Mailing Address - Country:US
Mailing Address - Phone:201-787-3954
Mailing Address - Fax:
Practice Address - Street 1:200 SCHLEY ST APT 308
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-2350
Practice Address - Country:US
Practice Address - Phone:201-787-3954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00543600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant