Healthcare Provider Details

I. General information

NPI: 1619065075
Provider Name (Legal Business Name): JENNIFER L TWARDZIK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 BRIGANTINE BLVD
BRIGANTINE NJ
08203
US

IV. Provider business mailing address

3400 BRIGANTINE BLVD
BRIGANTINE NJ
08203-1053
US

V. Phone/Fax

Practice location:
  • Phone: 609-266-7557
  • Fax: 609-266-4450
Mailing address:
  • Phone: 609-266-7557
  • Fax: 609-266-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB07015800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: