Healthcare Provider Details

I. General information

NPI: 1225841117
Provider Name (Legal Business Name): JESSICA LAUREN MOSS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE 1 LINK
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

1331 NEWMAN SPRINGS RD BLDG 2, STE 220
RED BANK NJ
07701-5688
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-1333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00908800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00908800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: