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General NPI Number Information
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NPI Number | 1053853440
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Entity Type | Organization
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Legal Business Name | JKOR, LLC
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 165 THIRD ST SUITE 4B
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City | BORDENTOWN
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State | NJ
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Zip | 08505-1800
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Country | US
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Telephone | 609-865-2670
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Fax |
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Provider Business Mailing Address
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Address Line | 165 THIRD ST SUITE 4B
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City | BORDENTOWN
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State | NJ
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Zip | 08505-1800
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Country | US
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Telephone | 609-865-2670
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Fax |
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Authorized Official
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Title or Position | PARTNER/ PROVIDER
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Name | JENNIFER S KRENCICKI
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Credential | LPC
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Telephone | 609-865-2670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 37AC00324600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 37PC00283600
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License Number State | NJ
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