Provider Demographics
NPI:1215390877
Name:LANDER, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:LANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 LIPPINCOTT DR STE E
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4168
Mailing Address - Country:US
Mailing Address - Phone:856-983-1900
Mailing Address - Fax:856-983-5110
Practice Address - Street 1:406 LIPPINCOTT DR STE E
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4168
Practice Address - Country:US
Practice Address - Phone:856-983-1900
Practice Address - Fax:856-983-5110
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11254300207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology