Provider Demographics
NPI:1922623115
Name:HAGEL, DYLAN MITCHELL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:MITCHELL
Last Name:HAGEL
Suffix:
Gender:M
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 1:40 CROSS RD APT 39
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-1105
Mailing Address - Country:US
Mailing Address - Phone:610-764-1804
Mailing Address - Fax:
Practice Address - Street 1:1820 STATE ROUTE 33 STE 4B
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4860
Practice Address - Country:US
Practice Address - Phone:732-776-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPA-GTL-20-00749363A00000X
NJ25MP00576900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant