Provider Demographics
NPI:1619065075
Name:TWARDZIK, JENNIFER L (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:TWARDZIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 BRIGANTINE BLVD
Mailing Address - Street 2:
Mailing Address - City:BRIGANTINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08203-1053
Mailing Address - Country:US
Mailing Address - Phone:609-266-7557
Mailing Address - Fax:609-266-4450
Practice Address - Street 1:3400 BRIGANTINE BLVD
Practice Address - Street 2:
Practice Address - City:BRIGANTINE
Practice Address - State:NJ
Practice Address - Zip Code:08203
Practice Address - Country:US
Practice Address - Phone:609-266-7557
Practice Address - Fax:609-266-4450
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07015800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8205507Medicaid
NJ037716CN9Medicare PIN
H15370Medicare UPIN
TW037716Medicare ID - Type Unspecified
NJ037716SBVMedicare PIN