Provider Demographics
NPI:1518175165
Name:PESKA MOSSERI, JODI LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:LYNN
Last Name:PESKA MOSSERI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TIMOTHY LANE
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-306-4935
Mailing Address - Fax:732-238-7115
Practice Address - Street 1:10 TIMOTHY LANE
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-306-4935
Practice Address - Fax:732-238-7115
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MBO6411000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics