Provider Demographics
NPI:1295938579
Name:BLUME, JESSICA W (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:W
Last Name:BLUME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:W
Other - Last Name:FEINHALS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:44 GODWIN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1959
Mailing Address - Country:US
Mailing Address - Phone:201-445-2900
Mailing Address - Fax:
Practice Address - Street 1:44 GODWIN AVE STE 300
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1959
Practice Address - Country:US
Practice Address - Phone:201-445-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231243-1207K00000X
NJ25MA08064400207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology