Basic Information
| Provider Information | |||||||||
| NPI: | 1407209349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAI | ||||||||
| FirstName: | JENNY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 829642 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191829642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664706626 | ||||||||
| FaxNumber: | 4135990470 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ROBERT WOOD JOHNSON PL | ||||||||
| Address2: | |||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328283000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2016 | ||||||||
| LastUpdateDate: | 07/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2017-00820 | NC | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 25MA10346400 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1407209349 | 05 | NC | MEDICAID | 19QWG | 01 | NC | BCBS OF NC | OTHER | NCY574A | 01 | NC | MEDICARE | OTHER |