Mojica-Itidiare, Jennifer

Mojica-Itidiare, Jennifer is an sole proprietor health care provider with primary practice located at 1 Medical Center Dr Suite 163, Stratford NJ 08084-1500. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Mojica-Itidiare, Jennifer can be contacted via phone (856) 677-6708.

Contact Information

Primary practice address
1 Medical Center Dr Suite 163 Stratford NJ 08084-1500
Phone: (856) 677-6708
Fax: (856) 566-6222
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 25MB09620200 New Jersey

Profile Details

NPI number 1508129172
LBN Legal business name Mojica-Itidiare, Jennifer
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 19th, 2012
Last updated Feb 10th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508129172 NPPES
New Jersey MEDICAID 0474550

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