Provider Demographics
NPI:1346559374
Name:LORETTA, JAIME MARIE (RPA-C)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:MARIE
Last Name:LORETTA
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 VICTORIAN WAY
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2103
Mailing Address - Country:US
Mailing Address - Phone:917-690-0461
Mailing Address - Fax:
Practice Address - Street 1:242 HIGHWAY 79 N STE 8
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-2079
Practice Address - Country:US
Practice Address - Phone:732-443-0300
Practice Address - Fax:551-236-2510
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013366-1363A00000X
IL085003663363A00000X
NJ25MP00280700363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant