# DR. EDWIN A. JENSEN, D.O., P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972514214
- **Authorized official:** DR. EDWIN ARNT JENSEN D.O. (PHYSICIAN)
- **Authorized official phone:** (856) 963-2187

## Contact information

- **Practice address:** 602 S BROADWAY, CAMDEN, NJ 08103-1222
- **Practice address phone:** (856) 963-2187
- **Practice address fax:** (856) 225-1913
- **Mailing address:** 602 S BROADWAY, CAMDEN, NJ 08103-1222
- **Mailing address phone:** (856) 963-2187
- **Mailing address fax:** (856) 225-1913

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 25MB02501900 | NJ | Yes |

## Other

- **Enumeration date:** 08/11/2006
- **Last updated:** 10/10/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01000075601 | AMERICHOICE | NJ |
| 01 | — | 0106612001 | AMERIHEALTH | NJ |
| 05 | — | 2787008 | — | NJ |
| 01 | — | 32866 | AMERIGROUP | NJ |