Healthcare Provider Details

I. General information

NPI: 1154767903
Provider Name (Legal Business Name): JENNIFER K PORCO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SEARS DR STE 306
PARAMUS NJ
07652-3510
US

IV. Provider business mailing address

1 SEARS DR STE 306
PARAMUS NJ
07652-3510
US

V. Phone/Fax

Practice location:
  • Phone: 201-830-2287
  • Fax: 201-830-2286
Mailing address:
  • Phone: 201-830-2287
  • Fax: 201-830-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00436900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: