Provider Demographics
NPI:1073576716
Name:HERBSTRITT, JENNIFER T (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:HERBSTRITT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 HOPEWELL WERTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08525-1107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 BRUNSWICK PIKE, SUITE 101A
Practice Address - Street 2:PROFESSIONAL HEALTHCARE SERVICES OF LAWRENCEVILLE
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4134
Practice Address - Country:US
Practice Address - Phone:609-771-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00218900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA095216KNCMedicare ID - Type UnspecifiedHGSA
PAQ54199Medicare UPIN
PA50054790OtherCAPITAL BLUE CROSS