Provider Demographics
NPI:1972973535
Name:BROWN, JENNY ANN (HIS)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:ANN
Other - Last Name:BLANDINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 SYLVAN LN
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-1928
Mailing Address - Country:US
Mailing Address - Phone:551-206-8707
Mailing Address - Fax:908-756-5261
Practice Address - Street 1:40 STIRLING RD
Practice Address - Street 2:SUITE 206B
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-5900
Practice Address - Country:US
Practice Address - Phone:908-756-5227
Practice Address - Fax:908-756-5261
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00128700237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MG00128700OtherSTATE HEARING AID DISPENSING LICENSE