Provider Demographics
NPI:1194990085
Name:MISLOW, JACQUELINE FORD (MD PHD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:FORD
Last Name:MISLOW
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MACLEAN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5621
Mailing Address - Country:US
Mailing Address - Phone:609-921-9516
Mailing Address - Fax:609-921-3018
Practice Address - Street 1:38 MACLEAN CIRCLE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5621
Practice Address - Country:US
Practice Address - Phone:609-921-9516
Practice Address - Fax:609-921-3018
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03628700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine