Healthcare Provider Details

I. General information

NPI: 1134485683
Provider Name (Legal Business Name): JENNIFER VOTTA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER GOMBERG D.O.

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E WASHINGTON ST
ANN ARBOR MI
48104-2017
US

IV. Provider business mailing address

901 MAPLE AVE
LINWOOD NJ
08221-1841
US

V. Phone/Fax

Practice location:
  • Phone: 734-328-2492
  • Fax: 734-234-5161
Mailing address:
  • Phone: 734-328-2492
  • Fax: 734-234-5161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number5101022402
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101022402
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: