Provider Demographics
NPI:1497394266
Name:PAUL, TREVOR (PA-C)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:PAUL
Suffix:
Gender:M
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 1:167 US HIGHWAY 9 STE 5
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-9215
Mailing Address - Country:US
Mailing Address - Phone:732-639-5500
Mailing Address - Fax:
Practice Address - Street 1:167 US HIGHWAY 9 STE 5
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-9215
Practice Address - Country:US
Practice Address - Phone:732-334-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00543400363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical