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General NPI Number Information
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NPI Number | 1346559374
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Entity Type | Individual
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Provider Name | JAIME MARIE LORETTA RPA-C
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Gender | Female
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Dates
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Enumeration Date | 09/24/2010
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 242 HIGHWAY 79 N STE 8
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City | MORGANVILLE
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State | NJ
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Zip | 07751-2079
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Country | US
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Telephone | 732-443-0300
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Fax | 551-236-2510
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Provider Business Mailing Address
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Address Line | 2 VICTORIAN WAY
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City | COLTS NECK
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State | NJ
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Zip | 07722-2103
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Country | US
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Telephone | 917-690-0461
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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 | 013366-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085003663
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00280700
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License Number State | NJ
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