Provider Demographics
NPI:1912124892
Name:MINTZ, JESSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:MINTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 AUER CT STE D
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5848
Mailing Address - Country:US
Mailing Address - Phone:732-254-7100
Mailing Address - Fax:732-254-7474
Practice Address - Street 1:10 AUER CT STE D
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5848
Practice Address - Country:US
Practice Address - Phone:732-254-7100
Practice Address - Fax:732-254-7474
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ36152103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)