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General NPI Number Information
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NPI Number | 1225841117
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Entity Type | Individual
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Provider Name | JESSICA LAUREN MOSS PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 855 VALLEY RD STE 112B
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City | CLIFTON
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State | NJ
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Zip | 07013-2441
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Country | US
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Telephone | 973-327-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 12 WASHINGTON CT
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City | TOWACO
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State | NJ
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Zip | 07082-1270
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Country | US
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Telephone | 973-487-6094
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00908800
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License Number State | NJ
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