Provider Demographics
NPI:1609948793
Name:NASH, JENNIFER (CAPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:NASH
Suffix:
Gender:F
Credentials:CAPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1401
Mailing Address - Country:US
Mailing Address - Phone:201-843-2800
Mailing Address - Fax:201-843-5848
Practice Address - Street 1:80 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1401
Practice Address - Country:US
Practice Address - Phone:201-843-2800
Practice Address - Fax:201-843-5848
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25NJ00118500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ105328B8LMedicare PIN
NJQ73613Medicare UPIN