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General NPI Number Information
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NPI Number | 1922278563
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Entity Type | Organization
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Legal Business Name | CELESTE A. JACQUE MD
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 201 S LIVINGSTON AVE SUITE 1A
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4043
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Country | US
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Telephone | 973-994-1500
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Fax | 973-994-1606
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Provider Business Mailing Address
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Address Line | 201 S LIVINGSTON AVE SUITE 1A
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4043
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Country | US
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Telephone | 973-994-1500
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Fax | 973-994-1606
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | SUSAN FRAGER
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Credential |
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Telephone | 636-464-8422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | MA042633
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License Number State | NJ
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