Provider Demographics
NPI:1609475326
Name:WHEALEN, REBECCA A (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:WHEALEN
Suffix:
Gender:
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 1:30 N DEAN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2807
Mailing Address - Country:US
Mailing Address - Phone:201-431-0321
Mailing Address - Fax:212-287-7210
Practice Address - Street 1:30 N DEAN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2807
Practice Address - Country:US
Practice Address - Phone:201-431-0321
Practice Address - Fax:212-287-7210
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029680363A00000X, 363AS0400X
NJ25MP00632900363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical