Provider Demographics
NPI:1346884640
Name:GOEZ, JESSICA MARCELLA (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARCELLA
Last Name:GOEZ
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:174 ROSALIE ST
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1840
Mailing Address - Country:US
Mailing Address - Phone:201-916-4964
Mailing Address - Fax:
Practice Address - Street 1:33 CEDAR ST STE 6
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2031
Practice Address - Country:US
Practice Address - Phone:914-251-9110
Practice Address - Fax:914-921-4877
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2022-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY026384363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant