Provider Demographics
NPI:1447292396
Name:AGNELLO, JENNIFER TERESA (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TERESA
Last Name:AGNELLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 POCONO RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2901
Mailing Address - Country:US
Mailing Address - Phone:973-664-9211
Mailing Address - Fax:973-664-9411
Practice Address - Street 1:16 POCONO RD
Practice Address - Street 2:SUITE 105
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2901
Practice Address - Country:US
Practice Address - Phone:973-664-9211
Practice Address - Fax:973-664-9411
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB60061207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ467985M4BMedicare ID - Type Unspecified
NJG40575Medicare UPIN