Provider Demographics
NPI:1134695828
Name:BOODY, JENNIFER CATHERINE (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CATHERINE
Last Name:BOODY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:125 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-2116
Mailing Address - Country:US
Mailing Address - Phone:631-560-5047
Mailing Address - Fax:
Practice Address - Street 1:106 CHARLES LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3632
Practice Address - Country:US
Practice Address - Phone:516-248-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2023-09-27
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant