Individual
JEANINE MARIE POTENZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
41 FAIRMOUNT AVE APT 8B, HACKENSACK, NJ 07601-4747
(201) 478-1547
Mailing address
PO BOX 1122, MAYWOOD, NJ 07607-7122
(201) 478-1547
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
00375093
NJ
Other
Enumeration date
07/20/2017
Last updated
03/17/2018
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