NPI 1679020556 · live from the CMS NPI Registry
Jessica Acquaviva, PA-C
Physician Assistant in Little Silver, NJ. National Provider Identifier 1679020556, active.
NPI record
| NPI | 1679020556 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 200 White Rd, Suite 115, Little Silver, NJ 07739 |
| Practice phone | 732-747-1925 |
| Mailing address | 1500 Saint Georges Ave, Avenel, NJ 07001 |
| Enumerated | September 8, 2016 |
| Last updated | April 6, 2022 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | — |
| Physician Assistant primary | 363A00000X | 25MP00411100 (NJ) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.