Provider Demographics
NPI:1932217387
Name:GRABOWSKI, JESSICA RUTH (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RUTH
Last Name:GRABOWSKI
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:22 OLD SHORT HILLS RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5604
Mailing Address - Country:US
Mailing Address - Phone:973-535-5800
Mailing Address - Fax:973-535-9550
Practice Address - Street 1:22 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5604
Practice Address - Country:US
Practice Address - Phone:973-535-5800
Practice Address - Fax:973-535-9550
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2009-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00123400363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ141029ZB9EMedicare PIN