Provider Demographics
NPI:1437121068
Name:PATERNO, JEANETTE DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:DIANE
Last Name:PATERNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10 BRASS CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-6309
Mailing Address - Country:US
Mailing Address - Phone:908-689-0777
Mailing Address - Fax:908-835-3036
Practice Address - Street 1:315 ROUTE 31 SOUTH
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882
Practice Address - Country:US
Practice Address - Phone:908-689-0777
Practice Address - Fax:908-835-3037
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO62923207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7318804Medicaid
NJ7318804Medicaid
NJG53930Medicare UPIN