NPI 1669355020 · live from the CMS NPI Registry
Aesthetic And Surgical Specialist, PC
Physician Assistant, Surgical in Wayne, NJ. National Provider Identifier 1669355020, active.
NPI record
| NPI | 1669355020 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant, Surgical 363AS0400X |
| Practice location | 401 Hamburg Tpke Ste 204, Wayne, NJ 07470 |
| Practice phone | 201-485-1243 |
| Mailing address | 762 Barnstable Ln, Franklin Lakes, NJ 07417 |
| Enumerated | July 30, 2025 |
| Last updated | July 30, 2025 |
| Authorized official | Carissa Vazquez, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant, Surgical primary | 363AS0400X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.