Provider Demographics
NPI:1538190327
Name:MONIZ-DUFFY, JENNIFER L (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MONIZ-DUFFY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 WASHINGTON ST
Mailing Address - Street 2:ADMINISTRATIVE OFFICE
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1607
Mailing Address - Country:US
Mailing Address - Phone:617-243-6435
Mailing Address - Fax:
Practice Address - Street 1:111 NORFOLK ST
Practice Address - Street 2:NEWTON-WELLESLEY FAMILY MEDICINE
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1703
Practice Address - Country:US
Practice Address - Phone:508-660-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2016320Medicaid
H93422Medicare UPIN
MA2016320Medicaid