Healthcare Provider Details

I. General information

NPI: 1487463428
Provider Name (Legal Business Name): EUNJIN ELENA JEONG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S WYCOMBE AVE
YEADON PA
19050-2835
US

IV. Provider business mailing address

235 GARFIELD AVE APT D
COLLINGSWOOD NJ
08108-3819
US

V. Phone/Fax

Practice location:
  • Phone: 610-626-8065
  • Fax:
Mailing address:
  • Phone: 201-675-8414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF312019-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP031665
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: