Basic Information
| Provider Information | |||||||||
| NPI: | 1124663505 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANGELONE | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | KRISTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 CATHERINE LN | ||||||||
| Address2: | |||||||||
| City: | MANAHAWKIN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080503612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089077510 | ||||||||
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| Practice Location | |||||||||
| Address1: | 103 OLD MARLTON PIKE | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080558772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097140202 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2019 | ||||||||
| LastUpdateDate: | 03/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 024336 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.