Provider Demographics
NPI:1780898585
Name:DE LA MOTA, JESSICA ISABEL (DO)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ISABEL
Last Name:DE LA MOTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ORONO ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2013
Mailing Address - Country:US
Mailing Address - Phone:973-779-2079
Mailing Address - Fax:
Practice Address - Street 1:380 2ND AVE
Practice Address - Street 2:10TH FLOOR SUITE 1000
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5615
Practice Address - Country:US
Practice Address - Phone:212-254-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08527900207L00000X
NY249970-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology