Provider Demographics
NPI:1497930515
Name:PRICE, JAMIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:TAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:25 POCONO RD
Mailing Address - Street 2:EMERGENCY DEPT
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2954
Mailing Address - Country:US
Mailing Address - Phone:973-625-6078
Mailing Address - Fax:
Practice Address - Street 1:25 POCONO RD
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2954
Practice Address - Country:US
Practice Address - Phone:973-625-6078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012161-1363A00000X
NJ25MP00312500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY094J31Medicare PIN