Provider Demographics
NPI:1295053056
Name:WIENER, JACLYN FAYE (DO)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:FAYE
Last Name:WIENER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:FAYE
Other - Last Name:BRITTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:75 E NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4532
Mailing Address - Country:US
Mailing Address - Phone:973-436-1540
Mailing Address - Fax:973-533-0197
Practice Address - Street 1:75 E NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4532
Practice Address - Country:US
Practice Address - Phone:973-436-1540
Practice Address - Fax:973-533-0197
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08748900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics