Healthcare Provider Details

I. General information

NPI: 1790966208
Provider Name (Legal Business Name): JESSICA SALAS MANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA SALAS MD

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HOSPITAL PLZ STE 330
OLD BRIDGE NJ
08857-3153
US

IV. Provider business mailing address

94 OLD SHORT HILLS RD STE 403
LIVINGSTON NJ
07039-5672
US

V. Phone/Fax

Practice location:
  • Phone: 732-786-7900
  • Fax: 732-490-7392
Mailing address:
  • Phone: 973-548-9900
  • Fax: 973-548-9500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number25MA08947600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number045972
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number257797
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: