Provider Demographics
NPI:1922432061
Name:JENNIFER R PEOS MD LLC
Entity Type:Organization
Organization Name:JENNIFER R PEOS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-597-1107
Mailing Address - Street 1:349 E NORTHFIELD RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4802
Mailing Address - Country:US
Mailing Address - Phone:973-597-1107
Mailing Address - Fax:973-597-1407
Practice Address - Street 1:349 E NORTHFIELD RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4802
Practice Address - Country:US
Practice Address - Phone:973-597-1107
Practice Address - Fax:973-597-1407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty