Provider Demographics
NPI:1861147449
Name:MOSCA, JILLIAN NICOLE
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:NICOLE
Last Name:MOSCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROCKWOOD PL STE 202
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4959
Mailing Address - Country:US
Mailing Address - Phone:315-520-9543
Mailing Address - Fax:
Practice Address - Street 1:1 W RIDGEWOOD AVE STE 110
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2361
Practice Address - Country:US
Practice Address - Phone:315-520-9543
Practice Address - Fax:201-444-9277
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-13
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00734700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant