Healthcare Provider Details

I. General information

NPI: 1396818076
Provider Name (Legal Business Name): JENNIFER BRIGHT DISMUKES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER BRIGHT HENSING D.O.

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 ORCHARD RD SUITE 2-6
SKILLMAN NJ
08558-2642
US

IV. Provider business mailing address

88 ORCHARD RD SUITE 2-6
SKILLMAN NJ
08558-2642
US

V. Phone/Fax

Practice location:
  • Phone: 609-228-6896
  • Fax: 940-293-8585
Mailing address:
  • Phone: 609-228-6896
  • Fax: 940-293-8585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM7951
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberM7951
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MB09244600
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number25MB09244600
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MB09244600
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberM7951
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: