Provider Demographics
NPI:1124464177
Name:SEMEL, JEFFREY SAMUEL
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:SAMUEL
Last Name:SEMEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HIGHLAND PL APT B
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2534
Mailing Address - Country:US
Mailing Address - Phone:973-762-7665
Mailing Address - Fax:973-762-2227
Practice Address - Street 1:40 CHATHAM RD
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2303
Practice Address - Country:US
Practice Address - Phone:973-379-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
28RW00012700183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician