Provider Demographics
NPI:1578828513
Name:SPIEGEL, JESSICA E (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:SPIEGEL
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 1:20 PROSPECT AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1941
Mailing Address - Country:US
Mailing Address - Phone:551-996-2608
Mailing Address - Fax:
Practice Address - Street 1:20 PROSPECT AVE STE 406
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1941
Practice Address - Country:US
Practice Address - Phone:551-996-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015691363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MP00692900OtherNJ STATE LICENSE
NY015-691OtherNY STATE LICENSE