Provider Demographics
NPI:1043584345
Name:PARRIS, JENISE CHARLENE (LAC MTOM)
Entity Type:Individual
Prefix:
First Name:JENISE
Middle Name:CHARLENE
Last Name:PARRIS
Suffix:
Gender:F
Credentials:LAC MTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 96TH ST
Mailing Address - Street 2:SUITE 14 B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6413
Mailing Address - Country:US
Mailing Address - Phone:646-320-8806
Mailing Address - Fax:
Practice Address - Street 1:110 W 96TH ST
Practice Address - Street 2:SUITE 14 B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6413
Practice Address - Country:US
Practice Address - Phone:646-320-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-04
Last Update Date:2012-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002647171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist