Provider Demographics
NPI:1366287591
Name:NOBLE, BASYA (PA-C)
Entity type:Individual
Prefix:
First Name:BASYA
Middle Name:
Last Name:NOBLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PRINCESS CT APT A
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3093
Mailing Address - Country:US
Mailing Address - Phone:718-986-1612
Mailing Address - Fax:
Practice Address - Street 1:6 PRINCESS CT APT A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3093
Practice Address - Country:US
Practice Address - Phone:718-986-1612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant