Provider Demographics
NPI:1821183344
Name:WOOD, JESSICA RACHEL (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RACHEL
Last Name:WOOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RACHEL
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:55 N GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4904
Mailing Address - Country:US
Mailing Address - Phone:732-842-6677
Mailing Address - Fax:732-530-2946
Practice Address - Street 1:55 N GILBERT ST
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4904
Practice Address - Country:US
Practice Address - Phone:732-842-6677
Practice Address - Fax:732-530-2946
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08069000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB08069000OtherMEDICAL LICENSE