Provider Demographics
NPI:1144269440
Name:WHITWORTH, JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:WHITWORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 MCBRIDE AVE
Mailing Address - Street 2:SUITE D203
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2559
Mailing Address - Country:US
Mailing Address - Phone:973-256-6350
Mailing Address - Fax:973-256-7388
Practice Address - Street 1:1031 MCBRIDE AVE
Practice Address - Street 2:SUITE D203
Practice Address - City:WEST PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07424-2559
Practice Address - Country:US
Practice Address - Phone:973-256-6350
Practice Address - Fax:973-256-7388
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA063604207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
223812197OtherHORIZON BCBS
60000896OtherMHP
P2145328OtherOXFORD
0376198000OtherAMERIHEALTH
31686OtherUNIVERSITY HEALTH PLAN
2K3839OtherHEALTHNET
2299410OtherGHI
NJ8050708Medicaid
2881489OtherAETNA
91000267201OtherAMERICHOICE
NJ8050708Medicaid
31686OtherUNIVERSITY HEALTH PLAN