=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922217272
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH ANNE JENNISON MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 COLUMBIA RD MEYER-3
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07960-4640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-455-3306
-----------------------------------------------------
Fax | 973-455-4416
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 COLUMBIA RD MEYER-3
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07960-4640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-455-3306
-----------------------------------------------------
Fax | 973-455-4416
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083X0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Physician
-----------------------------------------------------
License Number | 25MA08180100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------