Provider Demographics
NPI:1396818076
Name:DISMUKES, JENNIFER BRIGHT (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BRIGHT
Last Name:DISMUKES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:BRIGHT
Other - Last Name:HENSING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:88 ORCHARD RD
Mailing Address - Street 2:SUITE 2-6
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-2642
Mailing Address - Country:US
Mailing Address - Phone:609-228-6896
Mailing Address - Fax:940-293-8585
Practice Address - Street 1:88 ORCHARD RD
Practice Address - Street 2:SUITE 2-6
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2642
Practice Address - Country:US
Practice Address - Phone:609-228-6896
Practice Address - Fax:940-293-8585
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM79512084P0800X, 2084P0804X, 2084P0802X
NJ25MB092446002084P0800X, 2084P0802X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191795701Medicaid
TX0079FTOtherBCBS
OK200121090AMedicaid
TX595410OtherVALUEOPTIONS
TX9310085OtherAETNA BEHAVIORAL HEALTH
TX0079FTOtherBCBS
TX613072Medicare PIN