Provider Demographics
NPI:1386519569
Name:JENNIFER DISMUKES, DO PRACTICE
Entity type:Organization
Organization Name:JENNIFER DISMUKES, DO PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DISMUKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-652-1410
Mailing Address - Street 1:88 ORCHARD RD STE 2-6
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-2642
Mailing Address - Country:US
Mailing Address - Phone:908-652-1410
Mailing Address - Fax:
Practice Address - Street 1:88 ORCHARD RD STE 2-6
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2642
Practice Address - Country:US
Practice Address - Phone:908-652-1410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JENNIFER DISMUKES, D.O.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)