Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 25MB11207800 | NJ |
N | 207Q00000X | Family Doctor | 261373 | NY |
N | 207QA0505X | Family Doctor - Adult Medicine | 272992 | MA |
NPI | 1205098530 |
---|---|
Provider Name | Dr. Jennifer A Kabak |
First Address | Mount Laurel, NJ 08054-1149 |
Second Address | Mount Laurel, NJ 08054-1149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2008 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1X6685 | (05) | NJ |