Basic Information
| Provider Information | |||||||||
| NPI: | 1073865887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TASSA | ||||||||
| FirstName: | NGNAM | ||||||||
| MiddleName: | JULIENNE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7250 PARKWAY DR | ||||||||
| Address2: | STE 500 | ||||||||
| City: | HANOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210761343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439490814 | ||||||||
| FaxNumber: | 4439490814 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 1ST AVE | ||||||||
| Address2: | BERNSTEIN PAVILLION, 6TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100091834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124202000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2012 | ||||||||
| LastUpdateDate: | 08/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 015930 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.