Provider Demographics
NPI:1891153797
Name:SUNKIN, JENNIFER (DMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SUNKIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3196 KENNEDY BLVD FLOOR 3
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-1471
Mailing Address - Country:US
Mailing Address - Phone:973-742-4200
Mailing Address - Fax:973-742-4202
Practice Address - Street 1:3196 KENNEDY BLVD STE 3
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2468
Practice Address - Country:US
Practice Address - Phone:201-325-8444
Practice Address - Fax:201-325-8447
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026290001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0526045Medicaid