Provider Demographics
NPI:1851004550
Name:PANIAGUA, JENNYFER
Entity Type:Individual
Prefix:
First Name:JENNYFER
Middle Name:
Last Name:PANIAGUA
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 1:96A SUBURBIA DR
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-6200
Mailing Address - Country:US
Mailing Address - Phone:201-681-8330
Mailing Address - Fax:
Practice Address - Street 1:96A SUBURBIA DR
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-6200
Practice Address - Country:US
Practice Address - Phone:201-681-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide