Provider Demographics
NPI:1427084466
Name:TAYLOR, JEFFREY A (PA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 RARITAN CENTER PKWY
Mailing Address - Street 2:CONCENTRA MEDICAL CENTER
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3625
Mailing Address - Country:US
Mailing Address - Phone:732-225-5454
Mailing Address - Fax:732-417-0003
Practice Address - Street 1:135 RARITAN CENTER PKWY
Practice Address - Street 2:CONCENTRA MEDICAL CENTER
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3625
Practice Address - Country:US
Practice Address - Phone:732-225-5454
Practice Address - Fax:732-417-0003
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00084300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S79827Medicare UPIN
NJ077815BW0Medicare PIN