Healthcare Provider Details

I. General information

NPI: 1669573101
Provider Name (Legal Business Name): DELAWARE INSTITUTE FOR REPRODUCTIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 CHURCHMANS RD STE 300
NEWARK DE
19702
US

IV. Provider business mailing address

140 ALLEN RD
BASKING RIDGE NJ
07920
US

V. Phone/Fax

Practice location:
  • Phone: 302-738-4600
  • Fax: 302-738-3508
Mailing address:
  • Phone: 866-762-3140
  • Fax: 973-290-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA JENCO
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 866-762-3140