Provider Demographics
NPI:1700076254
Name:SHAIN-ALVARO, JUDITH C (PA-C)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:C
Last Name:SHAIN-ALVARO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:C
Other - Last Name:SHAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:UNIVERSITY RADIOLOGY GROUP, PC
Mailing Address - Street 2:579A CRANBURY ROAD
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1075
Mailing Address - Country:US
Mailing Address - Phone:732-390-0040
Mailing Address - Fax:732-390-1856
Practice Address - Street 1:579A CRANBURY RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5426
Practice Address - Country:US
Practice Address - Phone:732-390-0040
Practice Address - Fax:732-390-1856
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00003500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant