Provider Demographics
NPI:1417069873
Name:ESQUIERES, JENNIFER REDFORD (PAC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:REDFORD
Last Name:ESQUIERES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 ROUTE 37 WEST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:732-797-3990
Mailing Address - Fax:732-797-3995
Practice Address - Street 1:129 ROUTE 37 WEST
Practice Address - Street 2:SUITE 3
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-797-3990
Practice Address - Fax:732-797-3995
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD750363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P67120Medicare UPIN
NJ061548Medicare ID - Type Unspecified