Basic Information
| Provider Information | |||||||||
| NPI: | 1992850887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AVERSA | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 406 N MANSFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | MARGATE CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 084021430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098273295 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2500 BERNVILLE RD | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196059453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103782000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 12/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD33319 | SC | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | MD 435724 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | MA54946 | NJ | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.