Provider Demographics
NPI:1801446554
Name:OSAE, GEORGE AHYIA JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:AHYIA
Last Name:OSAE
Suffix:JR
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 1:67 BUCKLAND DR
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-1115
Mailing Address - Country:US
Mailing Address - Phone:203-982-0417
Mailing Address - Fax:
Practice Address - Street 1:67 BUCKLAND DR
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704
Practice Address - Country:US
Practice Address - Phone:203-982-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CT4648363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty