Provider Demographics
NPI:1487463428
Name:JEONG, EUNJIN ELENA (NP)
Entity type:Individual
Prefix:
First Name:EUNJIN
Middle Name:ELENA
Last Name:JEONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 GARFIELD AVE APT D
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-3819
Mailing Address - Country:US
Mailing Address - Phone:201-675-8414
Mailing Address - Fax:
Practice Address - Street 1:600 S WYCOMBE AVE
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-2835
Practice Address - Country:US
Practice Address - Phone:610-626-8065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF312019-01363LA2200X
PASP031665363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health