Provider Demographics
NPI:1356371280
Name:TREMBLAY, JANINE MARIE (PHD, APN)
Entity type:Individual
Prefix:DR
First Name:JANINE
Middle Name:MARIE
Last Name:TREMBLAY
Suffix:
Gender:F
Credentials:PHD, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6015
Mailing Address - Country:US
Mailing Address - Phone:973-993-0945
Mailing Address - Fax:973-898-6675
Practice Address - Street 1:150 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6015
Practice Address - Country:US
Practice Address - Phone:973-993-0945
Practice Address - Fax:973-898-6675
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2005103TC0700X
NJ26NJ00064800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ484575Medicare PIN