Provider Demographics
NPI:1386844512
Name:DE JONG, ANN FRANCES (RN, PHD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:FRANCES
Last Name:DE JONG
Suffix:
Gender:F
Credentials:RN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CLAREMONT AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042
Mailing Address - Country:US
Mailing Address - Phone:973-744-2888
Mailing Address - Fax:
Practice Address - Street 1:215 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750
Practice Address - Country:US
Practice Address - Phone:973-476-6517
Practice Address - Fax:862-333-4950
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ305769364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ839402Medicare PIN