Basic Information
| Provider Information | |||||||||
| NPI: | 1184052334 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STILLMAN | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 DEERFIELD RD | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078633500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452247607 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 POCONO RD | ||||||||
| Address2: | |||||||||
| City: | DENVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078342954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736256000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2013 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.