Provider Demographics
NPI:1538169909
Name:CLAIRVIL, JESSIE (DO)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:CLAIRVIL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 BECKETT RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1547
Mailing Address - Country:US
Mailing Address - Phone:856-339-0800
Mailing Address - Fax:856-339-0884
Practice Address - Street 1:545 BECKETT RD
Practice Address - Street 2:SUITE 206
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1547
Practice Address - Country:US
Practice Address - Phone:856-339-0800
Practice Address - Fax:856-339-0884
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2014-03-04
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07620000207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology