Basic Information
| Provider Information | |||||||||
| NPI: | 1538735410 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOLAN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | REBECCA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OBAT NAVIGATOR, CMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 134 DORADO DR | ||||||||
| Address2: | |||||||||
| City: | DELRAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080752029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2672585102 | ||||||||
| FaxNumber: | 8565964043 | ||||||||
| Practice Location | |||||||||
| Address1: | 73 N MAPLE AVE STE B | ||||||||
| Address2: | |||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080531782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8445422273 | ||||||||
| FaxNumber: | 8565964043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2021 | ||||||||
| LastUpdateDate: | 06/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1952726796 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.