Provider Demographics
NPI:1689904161
Name:ABDUL-GHANI, SAFIYYA (PA)
Entity Type:Individual
Prefix:
First Name:SAFIYYA
Middle Name:
Last Name:ABDUL-GHANI
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 1:450 CRESSON BLVD
Mailing Address - Street 2:ST 110
Mailing Address - City:OAKS
Mailing Address - State:PA
Mailing Address - Zip Code:19456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 CRESSON BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:OAKS
Practice Address - State:PA
Practice Address - Zip Code:19456
Practice Address - Country:US
Practice Address - Phone:610-728-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053979363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant