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General NPI Number Information
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NPI Number | 1902048978
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Entity Type | Individual
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Provider Name | MICHAEL EDWARD JENSEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/06/2009
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Last Update Date | 06/16/2014
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Provider Practice Location Address
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Address Line | 224 FLORENCE RD
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City | HARRINGTON PARK
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State | NJ
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Zip | 07640-1410
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Country | US
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Telephone | 917-930-0413
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Fax | 201-621-0115
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Provider Business Mailing Address
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Address Line | 224 FLORENCE RD
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City | HARRINGTON PARK
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State | NJ
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Zip | 07640-1410
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Country | US
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Telephone | 917-930-0413
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Fax | 201-621-0115
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 251817
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA08565900
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License Number State | NJ
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