1639266638 NPI number — JENNIFER A JARECKI DO

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639266638 NPI number — JENNIFER A JARECKI DO

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

JARECKI

Provider First Name:

JENNIFER

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

DO

Provider Gender Code:

F

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:

1639266638

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/25/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3 COOPER PLZ

Provider Second Line Business Mailing Address:

SUITE 502

Provider Business Mailing Address City Name:

CAMDEN

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

08103-1438

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

856-968-7433

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1 COOPER PLZ

Provider Second Line Business Practice Location Address:

COOPER UNIVERSITY EMERGNECY PHYSICIANS

Provider Business Practice Location Address City Name:

CAMDEN

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08103-1461

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

856-342-2930

Provider Business Practice Location Address Fax Number:

856-968-8272

Provider Enumeration Date:

10/10/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207P00000X , with the licence number:  MB65945 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0644437000 . This is a "AMERIHEALTH/KEYSTONE/IBC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 18402 . This is a "UNIVERSITY HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 3551680 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 4652315 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 60005670 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 010006259 00 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 766404 . This is a "AMERIHEALTH PPO/PA BS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: P3345592 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 2151162 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 02660108 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 7978405 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".