Provider Demographics
NPI:1497218036
Name:KARAGIANES, ALICIA VILLAESCUSA (PA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:VILLAESCUSA
Last Name:KARAGIANES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1301
Mailing Address - Country:US
Mailing Address - Phone:844-542-2273
Mailing Address - Fax:856-282-6511
Practice Address - Street 1:205 E LAUREL RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1301
Practice Address - Country:US
Practice Address - Phone:844-542-2273
Practice Address - Fax:856-282-6511
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00539600363A00000X
PAMA060529363A00000X
ORPA209966363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant