Provider Demographics
NPI:1376587519
Name:WILKEN, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WILKEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E CRESCENT AVE
Mailing Address - Street 2:C/O HISTOPATHOLOGY SERVICES, LLC
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2922
Mailing Address - Country:US
Mailing Address - Phone:201-661-7280
Mailing Address - Fax:201-661-7297
Practice Address - Street 1:156 ROUTE 59
Practice Address - Street 2:SUITE C6
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5005
Practice Address - Country:US
Practice Address - Phone:845-369-4200
Practice Address - Fax:201-661-7297
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213470207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02223352Medicaid
NYH00365Medicare UPIN
NY02223352Medicaid