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General NPI Number Information
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NPI Number | 1124663505
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Entity Type | Individual
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Provider Name | JESSICA KRISTI ANGELONE
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Gender | Female
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Dates
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Enumeration Date | 11/09/2019
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 103 OLD MARLTON PIKE
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City | MEDFORD
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State | NJ
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Zip | 08055-8772
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Country | US
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Telephone | 609-714-0202
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Fax |
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Provider Business Mailing Address
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Address Line | 113 CATHERINE LN
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-3612
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Country | US
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Telephone | 908-907-7510
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 024336
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License Number State | NY
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