Provider Demographics
NPI:1174064349
Name:VAL, CASSANDRA ISCA (APN)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ISCA
Last Name:VAL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 DAVEY ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-6203
Mailing Address - Country:US
Mailing Address - Phone:908-247-7323
Mailing Address - Fax:
Practice Address - Street 1:246 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-942-1141
Practice Address - Fax:973-942-1250
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00723800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner