Provider Demographics
NPI:1316555873
Name:VENTOSO, JESSE MANUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:MANUEL
Last Name:VENTOSO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2805
Mailing Address - Country:US
Mailing Address - Phone:973-585-4415
Mailing Address - Fax:
Practice Address - Street 1:341 SMITH RD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2805
Practice Address - Country:US
Practice Address - Phone:973-585-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2339137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor