Healthcare Provider Details

I. General information

NPI: 1609924133
Provider Name (Legal Business Name): JESSICA J DINAPOLI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA J WOLSKI

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 WHITEHORSE MERCERVILLE RD SUITE 212
MERCERVILLE NJ
08619-3835
US

IV. Provider business mailing address

PO BOX 8500-8721
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 609-588-5081
  • Fax: 609-588-5086
Mailing address:
  • Phone: 609-815-7810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00165600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: