Healthcare Provider Details

I. General information

NPI: 1942901087
Provider Name (Legal Business Name): JAZMINE ALEYAH LOVE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WILLIAMSON ST
ELIZABETH NJ
07202-3625
US

IV. Provider business mailing address

711 ROSEWOOD AVE
ROSELLE NJ
07203-1527
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00803700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00803700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00803700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: