Provider Demographics
NPI:1225841117
Name:MOSS, JESSICA LAUREN (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:MOSS
Suffix:
Gender:F
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 1:12 WASHINGTON CT
Mailing Address - Street 2:
Mailing Address - City:TOWACO
Mailing Address - State:NJ
Mailing Address - Zip Code:07082-1270
Mailing Address - Country:US
Mailing Address - Phone:973-487-6094
Mailing Address - Fax:
Practice Address - Street 1:855 VALLEY RD STE 112B
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2441
Practice Address - Country:US
Practice Address - Phone:973-327-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00908800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant