Healthcare Provider Details

I. General information

NPI: 1629730288
Provider Name (Legal Business Name): JEFFREY NEIL EMILIANI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 STATE RT 3
CLIFTON NJ
07012-2328
US

IV. Provider business mailing address

780 STATE RT 3
CLIFTON NJ
07012-2328
US

V. Phone/Fax

Practice location:
  • Phone: 973-777-6767
  • Fax:
Mailing address:
  • Phone: 973-777-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00666200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1187761
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: