Provider Demographics
NPI:1386643500
Name:JENNINGS, MAUREEN B (DPM)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:B
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 ROUTE 88
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2371
Mailing Address - Country:US
Mailing Address - Phone:732-458-4911
Mailing Address - Fax:732-458-4922
Practice Address - Street 1:1451 ROUTE 88
Practice Address - Street 2:SUITE 8A
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-2371
Practice Address - Country:US
Practice Address - Phone:732-458-4911
Practice Address - Fax:732-458-4922
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2007-11-07
Deactivation Date:2006-04-05
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
NJMD001868213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1270880002Medicare NSC
NJ421514Medicare PIN
NJT51236Medicare UPIN