Provider Demographics
NPI:1538609151
Name:DIFABIO, ANGELA MARCIA (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARCIA
Last Name:DIFABIO
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 1:1 E. NEW YORK AVE
Mailing Address - Street 2:4TH FLOOR ADMIN
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-8283
Mailing Address - Country:US
Mailing Address - Phone:609-653-3265
Mailing Address - Fax:609-926-4311
Practice Address - Street 1:1645 HAVEN AVE
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226
Practice Address - Country:US
Practice Address - Phone:609-399-6263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00628000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical