Provider Demographics
NPI:1609817170
Name:JENKINS, DAVID WHEELER (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WHEELER
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CRESTMONT AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-1610
Mailing Address - Country:US
Mailing Address - Phone:609-882-6610
Mailing Address - Fax:
Practice Address - Street 1:2381 LAWRENCEVILLE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2025
Practice Address - Country:US
Practice Address - Phone:609-896-9500
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02319000207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3326802Medicaid
NJ3326802Medicaid
NJ520322Medicare ID - Type Unspecified