Provider Demographics
NPI:1376281972
Name:JEFFERSON, MARQUIS (PA-C)
Entity Type:Individual
Prefix:
First Name:MARQUIS
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:M
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 1:9 FAWN CT
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1643
Mailing Address - Country:US
Mailing Address - Phone:609-222-1880
Mailing Address - Fax:
Practice Address - Street 1:8001 US-130
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075
Practice Address - Country:US
Practice Address - Phone:856-461-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00693000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant