Provider Demographics
NPI:1336174275
Name:MOTTA, JANET (PA-C)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:MOTTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 GRAND STREET
Mailing Address - Street 2:JERSEY CITY MEDICAL CENTER, DEPT OF SURGERY
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302
Mailing Address - Country:US
Mailing Address - Phone:201-915-2525
Mailing Address - Fax:201-915-2192
Practice Address - Street 1:355 GRAND STREET
Practice Address - Street 2:JERSEY CITY MEDICAL CENTER, DEPT. OF CT SURGERY
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-915-2525
Practice Address - Fax:201-915-2192
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00146200363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
097080 DEFMedicare ID - Type Unspecified