Provider Demographics
NPI:1972960300
Name:SOARES, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SOARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2467 ROUTE 10
Mailing Address - Street 2:BUILDING 2 APT 5A
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-1357
Mailing Address - Country:US
Mailing Address - Phone:401-287-5423
Mailing Address - Fax:
Practice Address - Street 1:2467 ROUTE 10
Practice Address - Street 2:BUILDING 2 APT 5A
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-1357
Practice Address - Country:US
Practice Address - Phone:401-287-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist