Provider Demographics
NPI:1922024173
Name:TIZIANA PENSABENI JASPER,MD LLC
Entity Type:Organization
Organization Name:TIZIANA PENSABENI JASPER,MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:TIZIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENSABENI JASPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-778-4440
Mailing Address - Street 1:1135 CLIFTON AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3642
Mailing Address - Country:US
Mailing Address - Phone:973-778-4440
Mailing Address - Fax:973-778-4427
Practice Address - Street 1:1135 CLIFTON AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3642
Practice Address - Country:US
Practice Address - Phone:973-778-4440
Practice Address - Fax:973-778-4427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1922024173OtherLLC NPI
NJ1922024173OtherLLC NPI
NJG 34718Medicare UPIN
NJ88556BMTMedicare ID - Type Unspecified