Provider Demographics
NPI:1811998784
Name:CHEN-RELOVSKY, MINDY M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:M
Last Name:CHEN-RELOVSKY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:MINDY
Other - Middle Name:M
Other - Last Name:CHEN-RELOVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:12 HEADQUARTERS RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889-4018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 HEADQUARTERS RD
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889-4018
Practice Address - Country:US
Practice Address - Phone:908-777-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00125900363A00000X, 363AS0400X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086304AJBMedicaid
NJ1811998784OtherNPI