Provider Demographics
NPI:1265488951
Name:RESNICK MATRO, JENNIFER DAWN
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DAWN
Last Name:RESNICK MATRO
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:DAWN
Other - Last Name:RESNICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1029 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2943
Mailing Address - Country:US
Mailing Address - Phone:856-216-7117
Mailing Address - Fax:
Practice Address - Street 1:817 E GATE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1208
Practice Address - Country:US
Practice Address - Phone:856-778-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA075236207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ074147Medicare ID - Type Unspecified
NJH97546Medicare UPIN