1235167396 NPI number — MRS. JANIS JENKINS AU.D., CCC-A, FAAA

Table of content: MRS. JANIS JENKINS AU.D., CCC-A, FAAA (NPI 1235167396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235167396 NPI number — MRS. JANIS JENKINS AU.D., CCC-A, FAAA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENKINS
Provider First Name:
JANIS
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AU.D., CCC-A, FAAA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WATKIS
Provider Other First Name:
JANIS
Provider Other Middle Name:
Y
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
AU.D.,CCC-A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235167396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
158 ORLANDO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RARITAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08869-2124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-575-7800
Provider Business Mailing Address Fax Number:
908-575-7619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08540-5733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-520-0093
Provider Business Practice Location Address Fax Number:
609-520-0562
Provider Enumeration Date:
06/29/2006

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: 231H00000X , with the licence number:  25MG00077200 , 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)





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