Basic Information
| Provider Information | |||||||||
| NPI: | 1184120222 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOUGAN | ||||||||
| FirstName: | SASCHA | ||||||||
| MiddleName: | GABRIELLE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 393 MELROSE PL | ||||||||
| Address2: | |||||||||
| City: | SOUTH ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070791640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465914903 | ||||||||
| FaxNumber: | 9732907495 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 MADISON AVE FL B | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079606092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737755115 | ||||||||
| FaxNumber: | 9732857617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2018 | ||||||||
| LastUpdateDate: | 03/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 26NJ00816500 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 26NJ00816500 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.