Provider Demographics
NPI:1659612968
Name:CHOMSKY, JACLYN ALEXIS (APN)
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:ALEXIS
Last Name:CHOMSKY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-1104
Mailing Address - Country:US
Mailing Address - Phone:973-374-3020
Mailing Address - Fax:973-374-3120
Practice Address - Street 1:297 16TH AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-1104
Practice Address - Country:US
Practice Address - Phone:973-374-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00422200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner