MEDICARE: DR. JENNIFER A KABAK DO

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	207Q00000X	Family Medicine Physician	261373	NY
2	207QA0505X	Adult Medicine Physician	272992	MA
3	207Q00000X	Family Medicine Physician	25MB11207800	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	:	1205098530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER A KABAK DO

Provider Business Mailing Address
First Line	:	67 SLADES FERRY AVE STE 6708
Second Line	:
City	:	SOMERSET
State	:	MA
Zip	:	02726-1220
Country	:	US
Telephone Number	:	508-678-5633
Fax Number	:	508-673-5605

Provider Business Practice Location Address
First Line	:	67 SLADES FERRY AVE
Second Line	:
City	:	SOMERSET
State	:	MA
Zip	:	02726-1220
Country	:	US
Telephone Number	:	508-678-5633
Fax Number	:	508-673-5605

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

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	09/29/2023

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Directions to “ DR. JENNIFER A KABAK DO” Practice Location

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