Basic Information
| Provider Information | |||||||||
| NPI: | 1891001608 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEFFREY P TENNER, DO, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082102327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094631488 | ||||||||
| FaxNumber: | 6094634881 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082102327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094631488 | ||||||||
| FaxNumber: | 6094634881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2010 | ||||||||
| LastUpdateDate: | 08/31/2010 | ||||||||
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| AuthorizedOfficialLastName: | TENNER | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6094631488 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MB48174 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1393901 | 05 | NJ | MEDICAID | P1130691 | 01 | NJ | OXFORD | OTHER | 0211084000 | 01 | NJ | AMERIHEALTH | OTHER | 61144 | 01 | NJ | AETNA | OTHER |