Provider Demographics
NPI:1831898832
Name:AYITIAH, ABIGAIL A (APN)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:A
Last Name:AYITIAH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CHANCELLOR PARK DR
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2047
Mailing Address - Country:US
Mailing Address - Phone:609-553-6823
Mailing Address - Fax:
Practice Address - Street 1:505 HAMILTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1059
Practice Address - Country:US
Practice Address - Phone:609-553-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01447700363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology