Provider Demographics
NPI:1174108419
Name:MALABRE, JENNIFER (FHNP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:MALABRE
Suffix:
Gender:F
Credentials:FHNP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MALABRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FHNP
Mailing Address - Street 1:92 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1817
Mailing Address - Country:US
Mailing Address - Phone:973-803-4510
Mailing Address - Fax:
Practice Address - Street 1:92 FERRY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1817
Practice Address - Country:US
Practice Address - Phone:973-803-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01121600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty