Healthcare Provider Details

I. General information

NPI: 1013870641
Provider Name (Legal Business Name): JILLIAN NOEL SCIOSCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BURNSIDE AVE
CRANFORD NJ
07016-2630
US

IV. Provider business mailing address

116 HARRIETT ST
WANAQUE NJ
07465-2219
US

V. Phone/Fax

Practice location:
  • Phone: 908-447-0734
  • Fax: 908-488-5767
Mailing address:
  • Phone: 973-303-7238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86145
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: