Provider Demographics
NPI:1578368221
Name:JEFFERSON, EMILY C (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:C
Last Name:JEFFERSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 CENTRAL AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1505
Mailing Address - Country:US
Mailing Address - Phone:973-216-5683
Mailing Address - Fax:
Practice Address - Street 1:550 CENTRAL AVE STE 600
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1505
Practice Address - Country:US
Practice Address - Phone:908-795-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00915300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant