Provider Demographics
NPI:1720212111
Name:JENEWERI, ELSIE
Entity Type:Individual
Prefix:MS
First Name:ELSIE
Middle Name:
Last Name:JENEWERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 SICKLERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-2555
Mailing Address - Country:US
Mailing Address - Phone:856-513-6219
Mailing Address - Fax:856-513-6231
Practice Address - Street 1:419 SICKLERVILLE RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-2555
Practice Address - Country:US
Practice Address - Phone:856-513-6219
Practice Address - Fax:856-513-6231
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies