Healthcare Provider Details

I. General information

NPI: 1386554830
Provider Name (Legal Business Name): DR. JESSICA ARDIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 SOUTHERN BLVD
CHATHAM NJ
07928-1462
US

IV. Provider business mailing address

46 TULANE PL
LINCOLN PARK NJ
07035-1308
US

V. Phone/Fax

Practice location:
  • Phone: 973-370-9944
  • Fax: 973-813-7065
Mailing address:
  • Phone: 201-704-8158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00809700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: