Healthcare Provider Details

I. General information

NPI: 1164813010
Provider Name (Legal Business Name): JFK AMBULATORY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JAMES ST
EDISON NJ
08820-3938
US

IV. Provider business mailing address

80 JAMES ST
EDISON NJ
08820-3938
US

V. Phone/Fax

Practice location:
  • Phone: 732-321-7000
  • Fax: 732-318-3693
Mailing address:
  • Phone: 732-321-7000
  • Fax: 732-318-3693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONNA JENKINS
Title or Position: ACCOUNTS RECEIVABLE SUPERVISOR
Credential:
Phone: 732-321-7000