Provider Demographics
NPI:1770817074
Name:NIGAM, AMBER AUTUMN (PA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:AUTUMN
Last Name:NIGAM
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 1:409 JOYCE KILMER AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-3363
Mailing Address - Country:US
Mailing Address - Phone:732-418-0709
Mailing Address - Fax:732-418-0747
Practice Address - Street 1:409 JOYCE KILMER AVE STE 210
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-418-0709
Practice Address - Fax:732-418-0747
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00220300363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical