Healthcare Provider Details

I. General information

NPI: 1407717663
Provider Name (Legal Business Name): JENNIFER DWECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 LAUREL OAK RD
VOORHEES NJ
08043-4419
US

IV. Provider business mailing address

109 W PALMER AVE
WEST LONG BRANCH NJ
07764-1249
US

V. Phone/Fax

Practice location:
  • Phone: 732-962-0786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00982800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: