Provider Demographics
NPI:1881671873
Name:CAMPBELL, ALFRED P (PA)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:P
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:129 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3421
Mailing Address - Country:US
Mailing Address - Phone:732-933-0333
Mailing Address - Fax:732-933-0333
Practice Address - Street 1:65 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-268-7130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP00451363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS94310Medicare UPIN