Individual
DR. JENNIFER MOJICA-ITIDIARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1 MEDICAL CENTER DR, SUITE 163, STRATFORD, NJ 08084-1500
(856) 677-6708
(856) 566-6222
Mailing address
151 FRIES MILL RD STE 301, TURNERSVILLE, NJ 08012-2016
(856) 513-4124
(856) 302-5932
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MB09620200
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0474550
—
NJ
Enumeration date
06/19/2012
Last updated
02/10/2020
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