Provider Demographics
NPI:1487691804
Name:GOPEZ, JENNIFER VALLARTA (APN-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:VALLARTA
Last Name:GOPEZ
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PALACE CT
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-2176
Mailing Address - Country:US
Mailing Address - Phone:732-690-3473
Mailing Address - Fax:
Practice Address - Street 1:1 ROBERT WOOD JOHNSON PL BLDG 5TH
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1928
Practice Address - Country:US
Practice Address - Phone:732-235-7231
Practice Address - Fax:732-235-8963
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04423700207RC0000X
NJ26NN111089363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP39432Medicare UPIN
NJ050689Medicare ID - Type Unspecified