Individual
JENNIFER GOONETILLEKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
32 S DEAN ST, ENGLEWOOD, NJ 07631-3515
(000) 000-0000
Mailing address
51 ROSELAND AVE APT 18, CALDWELL, NJ 07006-5923
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00408700
NJ
363A00000X
Physician Assistant
9004287
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0674184
—
NJ
Enumeration date
08/04/2015
Last updated
05/05/2025
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