Provider Demographics
NPI:1861032740
Name:OFFIAH, DORATHY (APN)
Entity Type:Individual
Prefix:
First Name:DORATHY
Middle Name:
Last Name:OFFIAH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 MOUNT PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2907
Mailing Address - Country:US
Mailing Address - Phone:973-483-3640
Mailing Address - Fax:
Practice Address - Street 1:540 S WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-3232
Practice Address - Country:US
Practice Address - Phone:908-862-2893
Practice Address - Fax:908-862-5810
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00966500363L00000X, 363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily