Provider Demographics
NPI:1346559374
Name:LORETTA, JAIME MARIE (RPA-C)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:MARIE
Last Name:LORETTA
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 RIVERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1371
Mailing Address - Country:US
Mailing Address - Phone:917-690-0461
Mailing Address - Fax:
Practice Address - Street 1:4143 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5637
Practice Address - Country:US
Practice Address - Phone:718-966-5556
Practice Address - Fax:718-966-7483
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00280700363AM0700X
IL085003663363A00000X
NY013366-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical