Provider Demographics
NPI:1598952343
Name:MCCARTHY, JENNIFER BEVERLY (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BEVERLY
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 LYONS AVE
Mailing Address - Street 2:G4
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2027
Mailing Address - Country:US
Mailing Address - Phone:973-926-8590
Mailing Address - Fax:973-926-6758
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:G4
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-8590
Practice Address - Fax:973-926-6758
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00069200363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ50701Medicare UPIN
NJ093835Medicare PIN