Provider Demographics
NPI:1750524435
Name:ZOSCHAK, JASMINE MARTINEZ (PA)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:MARTINEZ
Last Name:ZOSCHAK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 RYKOWSKI LN 101
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4055
Mailing Address - Country:US
Mailing Address - Phone:845-692-0030
Mailing Address - Fax:845-692-0037
Practice Address - Street 1:1592 ROUTE 739
Practice Address - Street 2:
Practice Address - City:DINGMANS FERRY
Practice Address - State:PA
Practice Address - Zip Code:18328-3477
Practice Address - Country:US
Practice Address - Phone:570-828-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-11
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003175L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant