Provider Demographics
NPI:1154493823
Name:MARIANI, JENNIFER A (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:MARIANI
Suffix:
Gender:F
Credentials:RPA-C
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 668
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-487-3420
Mailing Address - Fax:585-276-1956
Practice Address - Street 1:500 RED CREEK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4284
Practice Address - Country:US
Practice Address - Phone:585-487-3420
Practice Address - Fax:585-276-1956
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY5316207V00000X
NY005316363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005316OtherNYS LICENSE NUMBER
NYDD5036Medicare ID - Type UnspecifiedMEDICARE I.D. NUMBER