Alisa G. Cullen, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

25MP00091800 Issued in NJ

Practice address

745 Northfield Ave
Suite 4
West Orange, NJ 07052-1144

Phone

(973) 736-0041

Fax

(973) 736-0044

NPI assigned

Feb 2, 2007

Last updated

Dec 3, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: acullen503420@direct.ahsys.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Physicians in Kidney Disease & Cell Therapies, PA

  • Nephrology Physician
  • Harrison, NJ
  • NPI 1740476209
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386028800000",
    "number": "1003954074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 NORTHFIELD AVE",
            "address_2": "SUITE 4",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070521144",
            "telephone_number": "973-736-0041",
            "fax_number": "973-736-0044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 NORTHFIELD AVE",
            "address_2": "SUITE 4",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070521144",
            "telephone_number": "973-736-0041",
            "fax_number": "973-736-0044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULLEN",
        "first_name": "ALISA",
        "middle_name": "G.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-02",
        "last_updated": "2013-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "25MP00091800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Robert Cristiano, DPT
• Cross County Orthopaedics
• Cryomed LLC
• Crystalline Health and Wellness
• CSH West Orange Lessee, LLC
• Kristen Cunningham
• Cypress Health Institute of New Jersey
• Yolanda Czerniawski, O.D.
• Kelly Elizabeth D'Urso, PTDPTNCS
• Marissa G D'Urso

• Medical Physician Assistant in West Orange, NJ
• Providers in West Orange, NJ by specialty
• Medical Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.