Provider Demographics
NPI:1730210741
Name:BRUZA-AUGATIS, MIRELA
Entity type:Individual
Prefix:
First Name:MIRELA
Middle Name:
Last Name:BRUZA-AUGATIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRELA
Other - Middle Name:
Other - Last Name:BRUZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPA-C
Mailing Address - Street 1:71 ROUTE 206
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4142
Mailing Address - Country:US
Mailing Address - Phone:908-685-1887
Mailing Address - Fax:
Practice Address - Street 1:71 ROUTE 206
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4142
Practice Address - Country:US
Practice Address - Phone:908-685-1887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011628363AM0700X
NJ25MP0002322100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA1845Medicare PIN