1851496673 NPI number — JENNIFER B COREN DO

Table of content: JENNIFER B COREN DO (NPI 1851496673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851496673 NPI number — JENNIFER B COREN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COREN
Provider First Name:
JENNIFER
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1851496673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
483 E COUNTY LINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HATBORO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19040-1204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-441-5670
Provider Business Mailing Address Fax Number:
215-441-5661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
483 E COUNTY LINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HATBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19040-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-441-5670
Provider Business Practice Location Address Fax Number:
215-441-5661
Provider Enumeration Date:
09/14/2006

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: 208000000X , with the licence number:  OS013183 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1017137480001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".