Provider Demographics
NPI:1447788070
Name:CASSIDY, JILLIAN JOSEPHINE
Entity Type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:JOSEPHINE
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BERNARD DR
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2692
Mailing Address - Country:US
Mailing Address - Phone:917-282-1001
Mailing Address - Fax:
Practice Address - Street 1:64 BERNARD DR
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2692
Practice Address - Country:US
Practice Address - Phone:917-282-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant