Provider Demographics
NPI:1912959099
Name:PROCOPIO, JENNIFER L (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:PROCOPIO
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2301 S. BROAD STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-3542
Mailing Address - Country:US
Mailing Address - Phone:215-952-9936
Mailing Address - Fax:215-952-1247
Practice Address - Street 1:2301 S. BROAD STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3542
Practice Address - Country:US
Practice Address - Phone:215-952-9936
Practice Address - Fax:215-952-1247
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-01-20
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB07811900207Q00000X
PAOS013413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0102938Medicaid
PA102106001Medicaid
NJI 48210Medicare UPIN
PA097358JSHMedicare UPIN