Provider Demographics
NPI:1083857858
Name:JETHVA, REENA NATWARLAL (MD)
Entity Type:Individual
Prefix:
First Name:REENA
Middle Name:NATWARLAL
Last Name:JETHVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:30 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1915
Mailing Address - Country:US
Mailing Address - Phone:551-996-5264
Mailing Address - Fax:551-996-5176
Practice Address - Street 1:3601 A STREET, 3RD FLOOR ACP, SUITE 3314
Practice Address - Street 2:ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1095
Practice Address - Country:US
Practice Address - Phone:215-427-5470
Practice Address - Fax:215-427-4393
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA09633500207SG0202X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical Genetics