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General NPI Number Information
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NPI Number | 1053845099
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Entity Type | Organization
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Legal Business Name | JENA MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 926 SAXON BLVD
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City | ORANGE CITY
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State | FL
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Zip | 32763-8313
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Country | US
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Telephone | 386-774-1881
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Fax | 386-774-1264
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Provider Business Mailing Address
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Address Line | 302 ADAMS CT
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City | EDGEWATER
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State | NJ
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Zip | 07020-1655
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Country | US
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Telephone | 347-542-6360
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BENJAMIN WEISS
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Credential |
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Telephone | 347-542-6360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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