Provider Demographics
NPI:1902048978
Name:JENSEN, MICHAEL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:224 FLORENCE RD
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640-1410
Mailing Address - Country:US
Mailing Address - Phone:917-930-0413
Mailing Address - Fax:201-621-0115
Practice Address - Street 1:224 FLORENCE RD
Practice Address - Street 2:
Practice Address - City:HARRINGTON PARK
Practice Address - State:NJ
Practice Address - Zip Code:07640-1410
Practice Address - Country:US
Practice Address - Phone:917-930-0413
Practice Address - Fax:201-621-0115
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251817208600000X
NJ25MA08565900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery