MEDICARE: DR. JENNIFER L BALOG PHARM 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	183500000X	Pharmacist	28RI03080500	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	:	1881862365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER L BALOG PHARM D.

Provider Business Mailing Address
First Line	:	60 BROOKWOOD PKWY
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-1809
Country	:	US
Telephone Number	:	732-766-5324
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 HIGHWAY 35
Second Line	:
City	:	HAZLET
State	:	NJ
Zip	:	07730-1505
Country	:	US
Telephone Number	:	732-739-2302
Fax Number	:

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

Provider Enumeration Date	:	02/18/2008
Last Update Date	:	02/18/2008

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