Individual
JILL KOSSOVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
10 FOREST AVE, PARAMUS, NJ 07652-5242
(201) 291-4040
(201) 291-0404
Mailing address
147 COLUMBIA TPKE, STE 308, FLORHAM PARK, NJ 07932-2145
(201) 845-9300
(201) 845-9301
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00125200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
161635466
TAX IDENTIFICATION #
NJ
Enumeration date
05/31/2005
Last updated
12/07/2016
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