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General NPI Number Information
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NPI Number | 1275773350
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Entity Type | Organization
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Legal Business Name | REGINALD A. JENKINS, M.D.,P.A.
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Dates
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Enumeration Date | 03/02/2009
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Last Update Date | 03/02/2009
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Provider Practice Location Address
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Address Line | 393 BLOOMFIELD AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3505
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Country | US
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Telephone | 973-746-8181
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Fax | 973-746-0599
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Provider Business Mailing Address
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Address Line | 393 BLOOMFIELD AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3505
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Country | US
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Telephone | 973-746-8181
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Fax | 973-746-0599
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Authorized Official
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Title or Position | OWNER
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Name | DR. REGINALD ALEXANDER JENKINS
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Credential | M.D.
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Telephone | 973-746-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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