Provider Demographics
NPI:1255460275
Name:MENA, JESSICA (DO)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:MENA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BISHOP PLACE
Mailing Address - Street 2:HURTADO HEALTH CENTER
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901
Mailing Address - Country:US
Mailing Address - Phone:848-932-7402
Mailing Address - Fax:732-932-8255
Practice Address - Street 1:11 BISHOP PLACE
Practice Address - Street 2:HURTADO HEALTH CENTER
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:843-832-7402
Practice Address - Fax:732-932-8255
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01417207Q00000X
NJ25MB09954200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine