Provider Demographics
NPI:1134132889
Name:CAM, JENNY (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:CAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HURON AVE
Mailing Address - Street 2:SUITE 1P
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3641
Mailing Address - Country:US
Mailing Address - Phone:201-656-6003
Mailing Address - Fax:201-656-4566
Practice Address - Street 1:10 HURON AVE
Practice Address - Street 2:SUITE 1P
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3641
Practice Address - Country:US
Practice Address - Phone:201-656-6003
Practice Address - Fax:201-656-4566
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04902500207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3980600Medicaid
E22263Medicare UPIN
NJ3980600Medicaid