Active NPI
Anna M Avanesyan, PA-C
- Physician Assistant
- Fair Lawn, NJ
National Provider Identifier
1306223045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 25MP00336500
- Practice address
- 17-15 Maple Ave Ste 100
Fair Lawn, NJ 07410-1552 - Phone
- (201) 794-8055
- Fax
- (201) 794-8086
- NPI assigned
- May 1, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 25MP00336500 | NJ | Primary |
Addresses
Primary practice location
17-15 Maple Ave Ste 100
Fair Lawn, NJ 07410-1552
Mailing address
17-15 Maple Ave Ste 100
Fair Lawn, NJ 07410-1552
Phone (201) 794-8055
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MP00336500 | NJ | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Occupational Medical Associates | Physician Assistant | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physician Assistant
- Fair Lawn, NJ
- NPI 1093122392
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430438400000",
"number": "1306223045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17-15 MAPLE AVE STE 100",
"city": "FAIR LAWN",
"state": "NJ",
"postal_code": "074101552",
"telephone_number": "201-794-8055",
"fax_number": "201-794-8086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17-15 MAPLE AVE STE 100",
"city": "FAIR LAWN",
"state": "NJ",
"postal_code": "074101552",
"telephone_number": "201-794-8055",
"fax_number": "201-794-8086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVANESYAN",
"first_name": "ANNA",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-01",
"last_updated": "2015-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NJ",
"license": "25MP00336500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fair Lawn, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.