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General NPI Number Information
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NPI Number | 1457542532
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Entity Type | Organization
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Legal Business Name | JESSIE CLAIRVIL, DO LLC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 545 BECKETT RD SUITE 206
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City | SWEDESBORO
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State | NJ
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Zip | 08085-1547
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Country | US
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Telephone | 856-339-0800
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Fax | 856-339-0884
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Provider Business Mailing Address
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Address Line | 545 BECKETT RD SUITE 206
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City | SWEDESBORO
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State | NJ
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Zip | 08085-1547
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Country | US
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Telephone | 856-339-0800
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Fax | 856-339-0884
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Authorized Official
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Title or Position | OTOLARYNGOLOGIST
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Name | DR. JESSIE CLAIRVIL
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Credential | D.O
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Telephone | 856-339-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 25MB07620000
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License Number State | NJ
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