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1033324645
MIYASARI RANOEWIDJOJO
HACKENSACK, NJ
NPI
1033324645
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: NJ 25MP00118300)
Enumeration Date
2007-05-14
Last Update Date
2007-12-13
Business Address
-- MIYASARI RANOEWIDJOJO PA C
30 PROSPECT AVE HACKENSACK UNIVERSITY MEDICAL CENTER
HACKENSACK, NJ 07601-1914
Phone number: 201-996-4614
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Mailing Address
-- MIYASARI RANOEWIDJOJO PA C
45 GENOBLE RD
MONTVILLE, NJ 07045
Phone number: 347-223-8788
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