Provider Demographics
NPI:1922278563
Name:CELESTE A. JACQUE MD
Entity Type:Organization
Organization Name:CELESTE A. JACQUE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-464-8422
Mailing Address - Street 1:201 S LIVINGSTON AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4043
Mailing Address - Country:US
Mailing Address - Phone:973-994-1500
Mailing Address - Fax:973-994-1606
Practice Address - Street 1:201 S LIVINGSTON AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4043
Practice Address - Country:US
Practice Address - Phone:973-994-1500
Practice Address - Fax:973-994-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0426332084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty