Provider Demographics
NPI:1831137876
Name:MENELL, JILL S (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:MENELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 MAIN ST
Mailing Address - Street 2:ST. JOSEPH'S REGIONAL MEDICAL CENTER
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2621
Mailing Address - Country:US
Mailing Address - Phone:973-754-2000
Mailing Address - Fax:973-754-3331
Practice Address - Street 1:703 MAIN ST
Practice Address - Street 2:ST. JOSEPH'S REGIONAL MEDICAL CENTER
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-2000
Practice Address - Fax:973-754-3331
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA068545002080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8337802Medicaid
089636B8AMedicare ID - Type Unspecified
NJ8337802Medicaid