Provider Demographics
NPI:1205098530
Name:KABAK, JENNIFER A (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:KABAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:67 SLADES FERRY AVE STE 6708
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-1220
Mailing Address - Country:US
Mailing Address - Phone:508-678-5633
Mailing Address - Fax:508-673-5605
Practice Address - Street 1:67 SLADES FERRY AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-1220
Practice Address - Country:US
Practice Address - Phone:508-678-5633
Practice Address - Fax:508-673-5605
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261373207Q00000X
MA272992207QA0505X
NJ25MB11207800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1X6685Medicaid