Provider Demographics
NPI:1881655686
Name:JEANLOUIE, ODLER (MD)
Entity Type:Individual
Prefix:DR
First Name:ODLER
Middle Name:
Last Name:JEANLOUIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 NORTHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5336
Mailing Address - Country:US
Mailing Address - Phone:973-731-1919
Mailing Address - Fax:973-731-0408
Practice Address - Street 1:60 NORTHFIELD AVE
Practice Address - Street 2:THE HEALTH INSTITUTE
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5336
Practice Address - Country:US
Practice Address - Phone:973-731-1919
Practice Address - Fax:973-731-0408
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61755207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7910304Medicaid
NJ7910304Medicaid
NJG24590Medicare UPIN