Provider Demographics
NPI:1992391288
Name:ISSA, MAYA A
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:A
Last Name:ISSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 RT 35 N.
Mailing Address - Street 2:
Mailing Address - City:SEASIDE HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08751
Mailing Address - Country:US
Mailing Address - Phone:732-793-2890
Mailing Address - Fax:732-793-2911
Practice Address - Street 1:1600 RT 35 N.
Practice Address - Street 2:
Practice Address - City:SEASIDE HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08751
Practice Address - Country:US
Practice Address - Phone:732-793-2890
Practice Address - Fax:732-793-2911
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02992100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist