Provider Demographics
NPI:1699969659
Name:CHAO, JESSICA (APN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CHAO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:GAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:5 FRANKLIN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3504
Mailing Address - Country:US
Mailing Address - Phone:973-759-5842
Mailing Address - Fax:
Practice Address - Street 1:5 FRANKLIN AVE STE 102
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3504
Practice Address - Country:US
Practice Address - Phone:973-240-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00565900207K00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology