Provider Demographics
NPI:1164160065
Name:MINIOVICH, MEGAN ERICKA (PA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ERICKA
Last Name:MINIOVICH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HAMPTON HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-1408
Mailing Address - Country:US
Mailing Address - Phone:201-421-5220
Mailing Address - Fax:
Practice Address - Street 1:43 HAMPTON HOUSE RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1408
Practice Address - Country:US
Practice Address - Phone:973-446-6606
Practice Address - Fax:973-446-6608
Is Sole Proprietor?:No
Enumeration Date:2022-05-22
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363A00000X
NJ25MP00713900363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant