Individual provider Active NPI

Jenna Danielle Moran, PA-C

  • Physician Assistant
  • Paramus, NJ
National Provider Identifier
1699511014
Registry record updated Nov 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00965300 Issued in NJ
Practice address
160 N State RT 17
Paramus, NJ 07652-2833
Phone
(201) 262-5437
NPI assigned
Jul 4, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 032459 NY
Physician Assistant 363A00000X 25MP00965300 NJ Primary

Addresses

Primary practice location

160 N State RT 17
Paramus, NJ 07652-2833

Mailing address

32 Upper High Crest Dr
West Milford, NJ 07480-3730

Other practice location 1

3959 Broadway
New York, NY 10032-1559
Phone (212) 305-5437

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20240912001646 NY Practitioner - Physician Assistant 8628518032 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
032459NYMDPharmacist
25MP00965300NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York CurrentSince Aug 30, 2024 Accepting new patients
Trustees of Columbia University in the City of New York Physician Assistant CurrentSince Aug 30, 2024 Accepting new patients
PM Pediatrics of Livingston, PLLC PastSince Nov 18, 2025 Accepting new patients

Locations

622 W 168th St
#2260
New York, NY 10032
Phone (212) 305-6204

3959 Broadway
New York, NY 10032
Phone (212) 304-7297

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1720051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762646400000",
    "number": "1699511014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 UPPER HIGH CREST DR",
            "city": "WEST MILFORD",
            "state": "NJ",
            "postal_code": "074803730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 N STATE RT 17",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "076522833",
            "telephone_number": "201-262-5437"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3959 Broadway",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100321559",
            "country_code": "US",
            "telephone_number": "212-305-5437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORAN",
        "first_name": "JENNA",
        "middle_name": "DANIELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-04",
        "last_updated": "2025-11-09",
        "certification_date": "2025-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "032459",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00965300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paramus, NJ

Sources for this page

Verify at the official NPI Registry.