1255194395 NPI number — JENNIFER LEAH READY

Table of content: JENNIFER LEAH READY (NPI 1255194395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255194395 NPI number — JENNIFER LEAH READY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
READY
Provider First Name:
JENNIFER
Provider Middle Name:
LEAH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1255194395
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
602 W. CUTHBERT BLVD
Provider Second Line Business Mailing Address:
UNIT 26, SUITE A
Provider Business Mailing Address City Name:
WESTMONT
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-946-5180
Provider Business Mailing Address Fax Number:
856-946-5181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 HADDONFIELD BERLIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-3514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-435-7007
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2024

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: 163W00000X , with the licence number:  26NR16186700 , 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: 26NJ15041100 , 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)