Provider Demographics
NPI:1942295076
Name:OWENSBY, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:OWENSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 WEST GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2844
Practice Address - Country:US
Practice Address - Phone:718-283-8894
Practice Address - Fax:718-635-7235
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06519800208000000X, 2080P0203X
NY2139652080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02285165Medicaid
NY0100712-01OtherAMERICHOICE
NY1000030187OtherAFFINITY HEALTH
NY135460101OtherHEALTH PLUS
NY40N0391OtherNEIGHBORHOOD HEALTH
NY4C4667OtherHEALTH NET
NY2246605OtherUNITED HEALTH CARE
NY8Q2301OtherEMPIRE BCBS
NY213965-A15OtherHEALTH FIRST
NJ0130001Medicaid