Provider Demographics
NPI:1275851834
Name:SON, JESSICA J (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:J
Last Name:SON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:190 N INDEPENDENCE MALL W
Mailing Address - Street 2:SUITE 701A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1554
Mailing Address - Country:US
Mailing Address - Phone:267-800-1009
Mailing Address - Fax:267-800-1869
Practice Address - Street 1:190 N INDEPENDENCE MALL W
Practice Address - Street 2:SUITE 701A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-1554
Practice Address - Country:US
Practice Address - Phone:267-800-1009
Practice Address - Fax:267-800-1869
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2017-04-17
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Provider Licenses
StateLicense IDTaxonomies
NY271154207R00000X
NJ25MA09966400207R00000X
PAMD459338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine