Provider Demographics
NPI:1861560336
Name:JONES, TAMIKA LILLIAN
Entity type:Individual
Prefix:MRS
First Name:TAMIKA
Middle Name:LILLIAN
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:TAMIKA
Other - Middle Name:LILLIAN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1050 MANTUA PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-1141
Mailing Address - Country:US
Mailing Address - Phone:856-853-0848
Mailing Address - Fax:856-853-1889
Practice Address - Street 1:1050 MANTUA PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:WENONAH
Practice Address - State:NJ
Practice Address - Zip Code:08090
Practice Address - Country:US
Practice Address - Phone:856-853-0848
Practice Address - Fax:856-853-1889
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07478300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics