Provider Demographics
NPI:1124022520
Name:HILL, JENNIFER (PA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:186 JORALEMON ST
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4356
Mailing Address - Country:US
Mailing Address - Phone:718-858-3263
Mailing Address - Fax:718-858-5095
Practice Address - Street 1:186 JORALEMON ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4356
Practice Address - Country:US
Practice Address - Phone:718-858-3263
Practice Address - Fax:718-858-5095
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY009515363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5444L1Medicare ID - Type Unspecified