Basic Information
Provider Information
NPI: 1578751228
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEWMAN
FirstName: CARA
MiddleName: B.
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5 2ND ST E
Address2:  
City: NEW PROVIDENCE
State: NJ
PostalCode: 079742251
CountryCode: US
TelephoneNumber: 4103404477
FaxNumber:  
Practice Location
Address1: 6701 N CHARLES ST
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212046808
CountryCode: US
TelephoneNumber: 4438492225
FaxNumber: 4438493094
Other Information
ProviderEnumerationDate: 10/09/2007
LastUpdateDate: 08/13/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XC03632MDY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000X012620NYN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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