Provider Demographics
NPI:1851496673
Name:COREN, JENNIFER B (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:COREN
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 1:483 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-1204
Mailing Address - Country:US
Mailing Address - Phone:215-441-5670
Mailing Address - Fax:215-441-5661
Practice Address - Street 1:483 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-1204
Practice Address - Country:US
Practice Address - Phone:215-441-5670
Practice Address - Fax:215-441-5661
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013183208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017137480001Medicaid