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NPI Code Detail

MEDICARE: JENCARE NEIGHBORHOOD MEDICAL NEW MARKET, LLC

MEDICARE: JENCARE NEIGHBORHOOD MEDICAL NEW MARKET, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy
2207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1568756948
Entity Type Code : Organization
Provider Name (Legal Business Name) : JENCARE NEIGHBORHOOD MEDICAL NEW MARKET, LLC
Provider Business Mailing Address
First Line : 1395 NW 167TH ST
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33169-5742
Country : US
Telephone Number : 305-628-6117
Fax Number :
Provider Business Practice Location Address
First Line : 48 NEWMARKET SQ
Second Line :
City : NEWPORT NEWS
State : VA
Zip : 23605-2721
Country : US
Telephone Number : 757-825-8030
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : MARY CHEN
Credential :
Telephone Number : 305-831-4722
Provider Enumeration Date : 06/03/2011
Last Update Date : 10/31/2024

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