Provider Demographics
NPI:1184670952
Name:MORRISON, JILL S (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:S
Last Name:MORRISON
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 1:350 ENGLE ST
Mailing Address - Street 2:1ST FLOOR BERRIE BUILDING
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1808
Mailing Address - Country:US
Mailing Address - Phone:201-568-5250
Mailing Address - Fax:201-568-5096
Practice Address - Street 1:350 ENGLE ST
Practice Address - Street 2:1ST FLOOR BERRIE BUILDING
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1808
Practice Address - Country:US
Practice Address - Phone:201-568-5250
Practice Address - Fax:201-568-5096
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06598300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6343708Medicaid
NJ6343708Medicaid
NJ57280Medicare UPIN