Provider Demographics
NPI:1669573101
Name:DELAWARE INSTITUTE FOR REPRODUCTIVE MEDICINE
Entity type:Organization
Organization Name:DELAWARE INSTITUTE FOR REPRODUCTIVE MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-762-3140
Mailing Address - Street 1:140 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920
Mailing Address - Country:US
Mailing Address - Phone:866-762-3140
Mailing Address - Fax:973-290-8370
Practice Address - Street 1:620 CHURCHMANS RD
Practice Address - Street 2:STE 300
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702
Practice Address - Country:US
Practice Address - Phone:302-738-4600
Practice Address - Fax:302-738-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC10002852DEOtherMEDICAL LICENSE
DE=========OtherEMPLOYER IDENTIFICATION #
DEC48780Medicare UPIN