Basic Information
Provider Information | |||||||||
NPI: | 1376787994 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FORBES | ||||||||
FirstName: | JENNIFER | ||||||||
MiddleName: | REBECCA HUGHES | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HUGHES | ||||||||
OtherFirstName: | JENNIFER | ||||||||
OtherMiddleName: | REBECCA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 95000 LB# 7550 | ||||||||
Address2: |   | ||||||||
City: | PHILADELPHIA | ||||||||
State: | PA | ||||||||
PostalCode: | 191957550 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8443621735 | ||||||||
FaxNumber: | 9732907495 | ||||||||
Practice Location | |||||||||
Address1: | 91 S JEFFERSON RD | ||||||||
Address2: | SUITE 200 | ||||||||
City: | WHIPPANY | ||||||||
State: | NJ | ||||||||
PostalCode: | 079811037 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9735386116 | ||||||||
FaxNumber: | 9735383712 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/27/2009 | ||||||||
LastUpdateDate: | 02/12/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25MA09900800 | NJ | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
No ID Information.