Provider Demographics
NPI:1588735690
Name:LUAN, JENNIFER X
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:X
Last Name:LUAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:X
Other - Last Name:LUAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:15 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1959
Mailing Address - Country:US
Mailing Address - Phone:609-213-8860
Mailing Address - Fax:
Practice Address - Street 1:12 ROSZEL RD STE A101
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6234
Practice Address - Country:US
Practice Address - Phone:609-520-0088
Practice Address - Fax:609-520-0087
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA070951208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8345007Medicaid
NJ8345007Medicaid