Healthcare Provider Details

I. General information

NPI: 1760076574
Provider Name (Legal Business Name): JASMINA VANBUREN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SCHOOL RD E STE 2
MARLBORO NJ
07746-2061
US

IV. Provider business mailing address

217 SAN FERNANDO DR
LAVALLETTE NJ
08735-1629
US

V. Phone/Fax

Practice location:
  • Phone: 732-866-9922
  • Fax: 732-866-9970
Mailing address:
  • Phone: 914-703-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26NJ01117900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: