Provider Demographics
NPI:1659778306
Name:ATIEH, VIRGINIA (APN)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:ATIEH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 HWY 35
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1090
Mailing Address - Country:US
Mailing Address - Phone:732-706-7200
Mailing Address - Fax:973-433-9761
Practice Address - Street 1:2080 HWY 35
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1090
Practice Address - Country:US
Practice Address - Phone:609-890-1050
Practice Address - Fax:609-890-0950
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00523000363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0445355Medicaid