Provider Demographics
NPI:1134766025
Name:SAVORGIANNAKIS, ISIDORA
Entity type:Individual
Prefix:
First Name:ISIDORA
Middle Name:
Last Name:SAVORGIANNAKIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ISIDORA
Other - Middle Name:
Other - Last Name:PAPAGIANNAKIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:140 PARK AVE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1049
Practice Address - Country:US
Practice Address - Phone:908-404-7880
Practice Address - Fax:908-285-7629
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NJ25MP00747800363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant