Provider Demographics
NPI:1275773350
Name:REGINALD A. JENKINS, M.D.,P.A.
Entity Type:Organization
Organization Name:REGINALD A. JENKINS, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-746-8181
Mailing Address - Street 1:393 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3505
Mailing Address - Country:US
Mailing Address - Phone:973-746-8181
Mailing Address - Fax:973-746-0599
Practice Address - Street 1:393 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3505
Practice Address - Country:US
Practice Address - Phone:973-746-8181
Practice Address - Fax:973-746-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center