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General NPI Number Information
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NPI Number | 1487463428
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Entity Type | Individual
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Provider Name | EUNJIN ELENA JEONG NP
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Gender | Female
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 600 S WYCOMBE AVE
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City | YEADON
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State | PA
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Zip | 19050-2835
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Country | US
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Telephone | 610-626-8065
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Fax |
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Provider Business Mailing Address
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Address Line | 235 GARFIELD AVE APT D
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City | COLLINGSWOOD
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State | NJ
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Zip | 08108-3819
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Country | US
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Telephone | 201-675-8414
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F312019-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP031665
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License Number State | PA
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