Provider Demographics
NPI:1093878456
Name:KUFFEL, JENNIFER MORAN (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MORAN
Last Name:KUFFEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:100 BAUER DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-3105
Mailing Address - Country:US
Mailing Address - Phone:201-651-0121
Mailing Address - Fax:201-651-0124
Practice Address - Street 1:100 BAUER DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-3105
Practice Address - Country:US
Practice Address - Phone:201-651-0121
Practice Address - Fax:201-651-0124
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01109900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088003PKEMedicare PIN