Provider Demographics
NPI:1316669203
Name:AHN, EVA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3222
Mailing Address - Country:US
Mailing Address - Phone:201-725-7000
Mailing Address - Fax:
Practice Address - Street 1:4235 MAIN ST STE 3K
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3969
Practice Address - Country:US
Practice Address - Phone:718-886-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant