Provider Demographics
NPI:1326507500
Name:JOSEPH, JENNY G (LPN)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:G
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 VOSE AVE
Mailing Address - Street 2:APT A15
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050
Mailing Address - Country:US
Mailing Address - Phone:781-244-3532
Mailing Address - Fax:
Practice Address - Street 1:787 VOSE AVE
Practice Address - Street 2:APT A15
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050
Practice Address - Country:US
Practice Address - Phone:781-244-3532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP07283800164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse