Provider Demographics
NPI:1033155932
Name:JANSSON, JOY G (PA)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:G
Last Name:JANSSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 N NEW RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2170
Mailing Address - Country:US
Mailing Address - Phone:609-646-4064
Mailing Address - Fax:609-272-8526
Practice Address - Street 1:258 N NEW RD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-2170
Practice Address - Country:US
Practice Address - Phone:609-646-4064
Practice Address - Fax:609-272-8526
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP00090500363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP01606Medicare UPIN
NJ076175DR7Medicare ID - Type Unspecified