Basic Information
| Provider Information | |||||||||
| NPI: | 1790193076 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUMGARTEN | ||||||||
| FirstName: | JEREMY | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CAPITAL WAY | ||||||||
| Address2: | |||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093034000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 197 RIDGEDALE AVE | ||||||||
| Address2: | |||||||||
| City: | CEDAR KNOLLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079272111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082172896 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2014 | ||||||||
| LastUpdateDate: | 09/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 25MP00341600 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.