Provider Demographics
NPI:1598905044
Name:LYNCH, JENNIFER ERIN (DPT)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:ERIN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 RIVERSIDE AVE APT 5B
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1029
Mailing Address - Country:US
Mailing Address - Phone:732-616-8193
Mailing Address - Fax:
Practice Address - Street 1:122 RIVERSIDE AVE APT 5B
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1029
Practice Address - Country:US
Practice Address - Phone:732-616-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01297400283XC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283XC2000XHospitalsRehabilitation HospitalChildren