Healthcare Provider Details

I. General information

NPI: 1710986195
Provider Name (Legal Business Name): JENNIFER RENEE PEOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 E NORTHFIELD RD SUITE 210
LIVINGSTON NJ
07039-4802
US

IV. Provider business mailing address

349 E NORTHFIELD RD SUITE 210
LIVINGSTON NJ
07039-4802
US

V. Phone/Fax

Practice location:
  • Phone: 973-597-1107
  • Fax: 973-597-1407
Mailing address:
  • Phone: 973-597-1107
  • Fax: 973-597-1407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06846000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: