Basic Information
| Provider Information | |||||||||
| NPI: | 1710206818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEJESUS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6045 KENNEDY BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | NORTH BERGEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070473246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018614443 | ||||||||
| FaxNumber: | 2018610941 | ||||||||
| Practice Location | |||||||||
| Address1: | 6045 KENNEDY BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | NORTH BERGEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070473246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018614443 | ||||||||
| FaxNumber: | 2018610941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2010 | ||||||||
| LastUpdateDate: | 07/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 25MAO9285100 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.