Provider Demographics
NPI:1841225026
Name:CABASSA, EDWIN (MSN,APRN,BC)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:CABASSA
Suffix:
Gender:M
Credentials:MSN,APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1411
Mailing Address - Country:US
Mailing Address - Phone:201-501-0564
Mailing Address - Fax:201-501-0564
Practice Address - Street 1:680 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1422
Practice Address - Country:US
Practice Address - Phone:973-977-6657
Practice Address - Fax:973-977-6658
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN10664700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily