Jacqueline Simonetti, PA-C

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

25MP00592300 Issued in NJ

Practice address

220 Sunset Rd Ste 2C
Willingboro, NJ 08046-1126

Phone

(609) 871-9500

Fax

(609) 871-0619

NPI assigned

Dec 15, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Poblete Dermatology LLCGroup PAC ID 5597986513, 5 clinicians

Warren S Kurnick M D Dermatology Group P aGroup PAC ID 5496847261, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Poblete Dermatology LLC

  • Dermatology Physician
  • Mercerville, NJ
  • NPI 1013322932
  Medicare reassignment Care Compare group NPD
• Warren S Kurnick M D Dermatology Group P a

  • Dermatology Physician
  • Willingboro, NJ
  • NPI 1205994928
  Medicare reassignment Care Compare group
• Aesthetic Dermatology, LLC

  • Dermatology Physician
  • Marlton, NJ
  • NPI 1750449104
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707091200000",
    "number": "1114513041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 MEADOW RD",
            "city": "PENNSVILLE",
            "state": "NJ",
            "postal_code": "080701222",
            "telephone_number": "856-430-6682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 SUNSET RD STE 2C",
            "city": "WILLINGBORO",
            "state": "NJ",
            "postal_code": "080461126",
            "telephone_number": "609-871-9500",
            "fax_number": "609-871-0619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONETTI",
        "first_name": "JACQUELINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-15",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NJ",
            "license": "25MP00592300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Jaron Shmuts, D.O.
• Showers of Love Inc (SOL Therapy)
• Francine M Siegel, M.D.
• Jaunlette Natreen Simmons, MS, OTR/L
• Monica V Simmons
• Simple Guidance
• Barbara J Skinner, RD
• Lori Sleeper, CRNA
• Smiles Ahead Childrens Dentistry, PC
• Briana Halena Smith, DOULA

• Dermatology Physician in Willingboro, NJ
• Providers in Willingboro, NJ by specialty
• Dermatology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.