Provider Demographics
NPI:1689668469
Name:SCALZO, JESSICA ANNE (CFNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:SCALZO
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:HAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 5TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5631
Mailing Address - Country:US
Mailing Address - Phone:646-880-4465
Mailing Address - Fax:
Practice Address - Street 1:126 5TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5631
Practice Address - Country:US
Practice Address - Phone:646-880-4465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010096219Medicaid
VA010096219Medicaid
VA005506L19Medicare PIN