| Doctor Name: | DR. JESSICA EDEN FAZEKAS |
| NPI Number: | 1609938281 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.O. |
| License Number: | 25MB08623000 |
| Business Practice Address: | 2201 Chapel Ave W Attn: Radiology Dept Cherry Hill, NJ - 080022048 |
| Business Phone Number: | 8566615473 |
| Business Fax Number: | 8564886507 |
| Mailing Address: | 2201 Chapel Ave W, Attn: Radiology Dept CHERRY HILL |
| State: | NJ |
| Postal Code: | 080022048 |
| Phone Number: | 8566615473 |
| Fax Number: | 8564886507 |
| NPI Enumeration Date: | 12/13/2006 |
| NPI Last Update Date: | 10/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | 25MB08623000 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |