Basic Information
| Provider Information | |||||||||
| NPI: | 1992736219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOSSERT-SQUERI | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | MARION | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN, BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5740 BERKSHIRE VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074389847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8663892727 | ||||||||
| FaxNumber: | 4012163854 | ||||||||
| Practice Location | |||||||||
| Address1: | 5740 BERKSHIRE VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074389847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8663892727 | ||||||||
| FaxNumber: | 4012163854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 03/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F333721-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 26NJ00076700 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.