Healthcare Provider Details

I. General information

NPI: 1417069873
Provider Name (Legal Business Name): JENNIFER REDFORD ESQUIERES PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 ROUTE 37 WEST SUITE 3
TOMS RIVER NJ
08755
US

IV. Provider business mailing address

129 ROUTE 37 WEST SUITE 3
TOMS RIVER NJ
08755
US

V. Phone/Fax

Practice location:
  • Phone: 732-797-3990
  • Fax: 732-797-3995
Mailing address:
  • Phone: 732-797-3990
  • Fax: 732-797-3995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMD750
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: