Healthcare Provider Details

I. General information

NPI: 1619423332
Provider Name (Legal Business Name): JESSICA AQUINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADISON AVE
MORRISTOWN NJ
07960-6136
US

IV. Provider business mailing address

30 CATTANO AVE APT 517
MORRISTOWN NJ
07960-6873
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-5000
  • Fax:
Mailing address:
  • Phone: 787-709-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number35031
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA11191200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: