Healthcare Provider Details

I. General information

NPI: 1962316653
Provider Name (Legal Business Name): JOCELYN SANANGO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 ROUTE 22
SPRINGFIELD NJ
07081-3110
US

IV. Provider business mailing address

90 ROUTE 22
SPRINGFIELD NJ
07081-3110
US

V. Phone/Fax

Practice location:
  • Phone: 973-467-2273
  • Fax:
Mailing address:
  • Phone: 973-467-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP01059400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: