Provider Demographics
NPI:1962662361
Name:SOCK, JENNIFER DEENEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DEENEY
Last Name:SOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 FITZWATERTOWN RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1338
Mailing Address - Country:US
Mailing Address - Phone:215-914-4400
Mailing Address - Fax:215-657-4887
Practice Address - Street 1:735 FITZWATERTOWN RD
Practice Address - Street 2:SUITE 4
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1338
Practice Address - Country:US
Practice Address - Phone:215-914-4400
Practice Address - Fax:215-657-4887
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435789207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024897710001Medicaid
PA194174L5JMedicare PIN