MEDICARE: DR. JACQUELINE A OWENS 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	208000000X	Pediatrics Physician	MA057429	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	:	1811007750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE A OWENS M.D.

Provider Business Mailing Address
First Line	:	395 PLEASANT VALLEY WAY
Second Line	:	THE PEDIATRIC GROUP OF WEST ORANGE
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2998
Country	:	US
Telephone Number	:	973-731-6100
Fax Number	:	973-731-0612

Provider Business Practice Location Address
First Line	:	395 PLEASANT VALLEY WAY
Second Line	:	THE PEDIATRIC GROUP OF WEST ORANGE
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2998
Country	:	US
Telephone Number	:	973-731-6100
Fax Number	:	973-731-0612

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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