Basic Information
| Provider Information | |||||||||
| NPI: | 1134327026 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUMMEL | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CELLINI | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | E. | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 205 E LAUREL RD | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080841301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563442415 | ||||||||
| FaxNumber: | 8563442315 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 PRINCETON AVE | ||||||||
| Address2: | |||||||||
| City: | WEST DEPTFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080963123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568750505 | ||||||||
| FaxNumber: | 8563840218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 04/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 25MB08815100 | NJ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0248657 | 05 | NJ | MEDICAID |