Provider Demographics
NPI:1255708277
Name:ESQUERRE, JENNIFER ALEXANDRIA (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALEXANDRIA
Last Name:ESQUERRE
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4261
Mailing Address - Country:US
Mailing Address - Phone:201-966-8403
Mailing Address - Fax:
Practice Address - Street 1:605 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-488-0488
Practice Address - Fax:201-488-5787
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01628100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist