Healthcare Provider Details

I. General information

NPI: 1235898008
Provider Name (Legal Business Name): JENNIFER LEIGH FURMATO I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 JACK MARTIN BLVD
BRICK NJ
08724
US

IV. Provider business mailing address

425 JACK MARTIN BLVD
BRICK NJ
08724
US

V. Phone/Fax

Practice location:
  • Phone: 732-865-6117
  • Fax:
Mailing address:
  • Phone: 732-865-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1650442
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00666400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: