Provider Demographics
NPI:1366509374
Name:CONSENTINO, JILL LEAH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:LEAH
Last Name:CONSENTINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 STONE HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722
Mailing Address - Country:US
Mailing Address - Phone:551-404-0142
Mailing Address - Fax:
Practice Address - Street 1:21 KILMER DRIVE BUILDING 2
Practice Address - Street 2:SUITE A
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751
Practice Address - Country:US
Practice Address - Phone:732-967-6444
Practice Address - Fax:732-967-6445
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NJ25MP00058300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant