Provider Demographics
NPI:1942240098
Name:POMPLIANO, JENNIFER D (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:POMPLIANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BAYONNE AVE
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07750-1001
Mailing Address - Country:US
Mailing Address - Phone:732-229-6797
Mailing Address - Fax:
Practice Address - Street 1:1019 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1326
Practice Address - Country:US
Practice Address - Phone:732-229-6797
Practice Address - Fax:732-229-6893
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB073931174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084509QXEMedicare ID - Type Unspecified
NJI19151Medicare UPIN