Provider Demographics
NPI:1013586171
Name:DEMOSTHENE, JENNIFER (APN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DEMOSTHENE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1950
Mailing Address - Country:US
Mailing Address - Phone:973-687-3272
Mailing Address - Fax:
Practice Address - Street 1:166 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2016
Practice Address - Country:US
Practice Address - Phone:973-926-8491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01359200363L00000X
NJ26NR20660900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse