Provider Demographics
NPI:1619289824
Name:PEDERSEN, HEATHER ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:PEDERSEN
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 1:1114 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-1610
Mailing Address - Country:US
Mailing Address - Phone:908-240-3471
Mailing Address - Fax:
Practice Address - Street 1:1450 ROUTE 22
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2619
Practice Address - Country:US
Practice Address - Phone:908-364-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant