Provider Demographics
NPI:1356700967
Name:BURGAGNI, MICHELE ASHLEY (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ASHLEY
Last Name:BURGAGNI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:ASHLEY
Other - Last Name:CHRISOSTOMOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 SCHULZ DR STE 2
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-6745
Mailing Address - Country:US
Mailing Address - Phone:732-426-3420
Mailing Address - Fax:
Practice Address - Street 1:74 BRICK BLVD STE 205
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7990
Practice Address - Country:US
Practice Address - Phone:732-426-3420
Practice Address - Fax:732-747-2606
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00389900363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical