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General NPI Number Information
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NPI Number | 1295100493
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Entity Type | Individual
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Provider Name | JESSICA CERASOLI PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/14/2015
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 219 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1519
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Country | US
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Telephone | 215-762-6620
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Fax |
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Provider Business Mailing Address
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Address Line | 169 GREENWOOD AVE APT. B5
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City | JENKINTOWN
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State | PA
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Zip | 19046-2626
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Country | US
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Telephone | 724-561-3313
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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 | C5-0001284
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA058021
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License Number State | PA
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