1255503892 NPI number — JENIKA MILES N.P.

Table of content: JENIKA MILES N.P. (NPI 1255503892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255503892 NPI number — JENIKA MILES N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILES
Provider First Name:
JENIKA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255503892
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 N. WHITE HORSE PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMONTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-567-0434
Provider Business Mailing Address Fax Number:
609-567-1169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
651 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08016-2737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-386-0775
Provider Business Practice Location Address Fax Number:
609-386-4372
Provider Enumeration Date:
03/24/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  26NJ00533700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: SP014222 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: SP021092 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SF0001X , with the licence number: 26NJ00533700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0442534 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".