Healthcare Provider Details

I. General information

NPI: 1437006889
Provider Name (Legal Business Name): JESSICA VELASQUEZ-JULCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WILLIAMSON ST STE 204
ELIZABETH NJ
07202-3671
US

IV. Provider business mailing address

2 CONVENT RD
MORRISTOWN NJ
07960-6923
US

V. Phone/Fax

Practice location:
  • Phone: 908-355-8877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP01004100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: