Provider Demographics
NPI:1356970180
Name:BAYAWA, MICHAEL ANGELO ATON (AGNP-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL ANGELO
Middle Name:ATON
Last Name:BAYAWA
Suffix:
Gender:M
Credentials:AGNP-C
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Mailing Address - Street 1:988 BROADWAY STE 201
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4036
Mailing Address - Country:US
Mailing Address - Phone:201-339-6333
Mailing Address - Fax:201-339-6111
Practice Address - Street 1:988 BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4036
Practice Address - Country:US
Practice Address - Phone:201-339-6333
Practice Address - Fax:201-339-6111
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01020000363L00000X, 363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology