Provider Demographics
NPI:1013935790
Name:LEVINE, JENNIFER (APN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 DAVIS AVE-9TH FL BEHAVIORAL HEATLH
Mailing Address - Street 2:MERIDIAN MEDICAL GROUP-FACULTY CARE
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-897-3640
Mailing Address - Fax:732-897-3639
Practice Address - Street 1:1200 JUMPING BROOK RD
Practice Address - Street 2:BLDG 5, STE 201
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-643-4363
Practice Address - Fax:732-643-4376
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00083700363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0080292Medicaid
NJ095869B25OtherMEDICARE