Provider Demographics
NPI:1821426800
Name:STRONGWATER, ASHLEY BLAKE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BLAKE
Last Name:STRONGWATER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 S 4TH ST APT 6A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-5372
Mailing Address - Country:US
Mailing Address - Phone:914-760-8014
Mailing Address - Fax:217-286-6107
Practice Address - Street 1:215 NORTH AVE W
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1491
Practice Address - Country:US
Practice Address - Phone:908-308-4500
Practice Address - Fax:217-286-6107
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP0061990363A00000X
NY016928363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016928OtherNY STATE LICENSE
NJ25MP0061990OtherNJ STATE LICENSE