Provider Demographics
NPI:1790827681
Name:SOLOMON, ANGEL NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:NICOLE
Last Name:SOLOMON
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 1:6208 HANA RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2583
Mailing Address - Country:US
Mailing Address - Phone:908-565-4731
Mailing Address - Fax:
Practice Address - Street 1:26 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1302
Practice Address - Country:US
Practice Address - Phone:973-672-1212
Practice Address - Fax:973-672-2722
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00091700363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical