MEDICARE: DR. DANIELLE LOUISA JARDINE M.B,B.S.

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	207R00000X	Internal Medicine Physician	261607	NY
2	207R00000X	Internal Medicine Physician	25MA09192200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154609055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE LOUISA JARDINE M.B,B.S.

Provider Business Mailing Address
First Line	:	120 MILLBURN AVE STE 204
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1935
Country	:	US
Telephone Number	:	201-221-6816
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 MILLBURN AVE STE 204
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1935
Country	:	US
Telephone Number	:	973-467-9282
Fax Number	:

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

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	07/21/2022

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