Provider Demographics
NPI:1114144805
Name:NEAD, JENNIFER ANNE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:NEAD
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 1:750 E ADAMS ST
Mailing Address - Street 2:SUNY UPSTATE MEDICAL UNIVERSITY, DEPT OF PEDIATRICS
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2342
Mailing Address - Country:US
Mailing Address - Phone:315-464-5450
Mailing Address - Fax:315-464-6322
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:SUNY UPSTATE MEDICAL UNIVERSITY, DEPT OF PEDIATRICS
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2342
Practice Address - Country:US
Practice Address - Phone:315-464-5450
Practice Address - Fax:315-464-6322
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3206208000000X
MO2011009253208000000X
NY265546208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03468155Medicaid
TX8L23211Medicare PIN
NYJ400075697Medicare PIN