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General NPI Number Information
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NPI Number | 1659600070
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Entity Type | Individual
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Provider Name | JESSICA E HENDERSON PA
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Gender | Female
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 32 CORBETT WAY
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City | EATONTOWN
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State | NJ
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Zip | 07724-2263
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Country | US
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Telephone | 732-460-9555
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Fax | 732-460-0699
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Provider Business Mailing Address
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Address Line | 32 CORBETT WAY
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City | EATONTOWN
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State | NJ
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Zip | 07724-2263
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Country | US
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Telephone | 732-460-9555
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Fax | 732-460-0699
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00230400
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License Number State | NJ
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