Healthcare Provider Details

I. General information

NPI: 1457921678
Provider Name (Legal Business Name): JESSE VEISBLATT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BRIGGS RD STE 250
MOUNT LAUREL NJ
08054-4111
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-866-7466
  • Fax: 856-866-9088
Mailing address:
  • Phone: 856-866-7466
  • Fax: 856-866-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT223516
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number25MA13021100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: