Provider Demographics
NPI:1205088374
Name:MORALES, JENNIFER NANCY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NANCY
Last Name:MORALES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:NANCY
Other - Last Name:LEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:815 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2309
Mailing Address - Country:US
Mailing Address - Phone:908-245-3446
Mailing Address - Fax:908-245-9265
Practice Address - Street 1:815 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-2309
Practice Address - Country:US
Practice Address - Phone:908-245-3446
Practice Address - Fax:908-245-9265
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00202200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant