MEDICARE: JEFFREY WHITWORTH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	MA063604	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	223812197	OTHER	HORIZON BCBS
2	60000896	OTHER	MHP
3	P2145328	OTHER	OXFORD
4	0376198000	OTHER	AMERIHEALTH
5	31686	OTHER	UNIVERSITY HEALTH PLAN
6	2K3839	OTHER	HEALTHNET
7	2299410	OTHER	GHI
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	2881489	OTHER	AETNA
10	91000267201	OTHER	AMERICHOICE

General Provider Information

NPI Number	:	1144269440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY WHITWORTH M.D.

Provider Business Mailing Address
First Line	:	1031 MCBRIDE AVE
Second Line	:	SUITE D203
City	:	WEST PATERSON
State	:	NJ
Zip	:	07424-2559
Country	:	US
Telephone Number	:	973-256-6350
Fax Number	:	973-256-7388

Provider Business Practice Location Address
First Line	:	1031 MCBRIDE AVE
Second Line	:	SUITE D203
City	:	WEST PATERSON
State	:	NJ
Zip	:	07424-2559
Country	:	US
Telephone Number	:	973-256-6350
Fax Number	:	973-256-7388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/30/2010

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