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General NPI Number Information
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NPI Number | 1073879870
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Entity Type | Individual
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Provider Name | JENNIFER GRANT BUDACKI D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 1272 W MAIN RD
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City | MIDDLETOWN
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State | RI
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Zip | 02842-6405
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Country | US
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Telephone | 401-847-2290
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Fax | 401-849-8446
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Provider Business Mailing Address
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Address Line | 1201 LANGHORNE NEWTOWN RD
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City | LANGHORNE
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State | PA
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Zip | 19047-1201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | OS017608
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | DO00939
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License Number State | RI
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