Individual provider Active NPI

Jessica Varghese

  • Physician Assistant
  • Nutley, NJ
National Provider Identifier
1972413003
Registry record updated Sep 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
123 Metro Blvd
Nutley, NJ 07110-6101
Phone
(973) 761-9000
NPI assigned
Sep 10, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

123 Metro Blvd
Nutley, NJ 07110-6101

Mailing address

24 Dalton PL
Bergenfield, NJ 07621-2603

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI Registry JSON

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

{
    "created_epoch": "1788998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788998400000",
    "number": "1972413003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 DALTON PL",
            "city": "BERGENFIELD",
            "state": "NJ",
            "postal_code": "076212603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 METRO BLVD",
            "city": "NUTLEY",
            "state": "NJ",
            "postal_code": "071106101",
            "telephone_number": "973-761-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VARGHESE",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-09-10",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nutley, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.