Provider Demographics
NPI:1174707632
Name:AZLIN, JOVIANE (PA)
Entity type:Individual
Prefix:MRS
First Name:JOVIANE
Middle Name:
Last Name:AZLIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JOVIANE
Other - Middle Name:
Other - Last Name:DESJARDINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:330 FULTON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1404
Mailing Address - Country:US
Mailing Address - Phone:646-247-6742
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:4 NORTH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012267363AM0700X
NJ25MP00511800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical