Provider Demographics
NPI:1578505178
Name:BILLER, JEANETTE MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:MARIE
Last Name:BILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:JEANETTE
Other - Middle Name:MARIE
Other - Last Name:SEMF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:510 HAMBURG TPKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2025
Mailing Address - Country:US
Mailing Address - Phone:973-942-6005
Mailing Address - Fax:973-942-6009
Practice Address - Street 1:510 HAMBURG TPKE
Practice Address - Street 2:STE 101
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2025
Practice Address - Country:US
Practice Address - Phone:973-942-6005
Practice Address - Fax:973-942-6009
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06692200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0303291Medicaid
NJ0303291Medicaid
NJ025640Medicare PIN