Provider Demographics
NPI:1568848448
Name:DHAMIJA, LANA (PA-C)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:DHAMIJA
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 1:6 MILL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2204
Mailing Address - Country:US
Mailing Address - Phone:973-617-0664
Mailing Address - Fax:
Practice Address - Street 1:4 TECHNOLOGY DR STE 180
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4068
Practice Address - Country:US
Practice Address - Phone:973-617-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00370500363A00000X
NY027215-01363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant