Provider Demographics
NPI:1326187949
Name:CRAWFORD, JENNIFER LEE (MPA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MPA-C
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:KOCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPA-C
Mailing Address - Street 1:750 VALLEY BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1301
Mailing Address - Country:US
Mailing Address - Phone:201-896-0900
Mailing Address - Fax:
Practice Address - Street 1:750 VALLEY BROOK AVE
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1301
Practice Address - Country:US
Practice Address - Phone:201-896-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00176200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant