Provider Demographics
NPI:1932314770
Name:JALOSJOS, JAN WARREN PIENCENAVES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAN WARREN
Middle Name:PIENCENAVES
Last Name:JALOSJOS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:304 CHESTNUT AVENUE
Mailing Address - Street 2:
Mailing Address - City:WOODLYNNE
Mailing Address - State:NJ
Mailing Address - Zip Code:08107
Mailing Address - Country:US
Mailing Address - Phone:267-307-5795
Mailing Address - Fax:
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052733363A00000X, 363AM0700X, 363AS0400X
PAOA002134363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical