Provider Demographics
NPI:1164785895
Name:HUSARENCU, JEANA DOINA (MD)
Entity Type:Individual
Prefix:MRS
First Name:JEANA
Middle Name:DOINA
Last Name:HUSARENCU
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 1:739 W 186TH ST
Mailing Address - Street 2:APT 6D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-8526
Mailing Address - Country:US
Mailing Address - Phone:212-740-6828
Mailing Address - Fax:
Practice Address - Street 1:739 W 186TH ST
Practice Address - Street 2:APT 6D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-8526
Practice Address - Country:US
Practice Address - Phone:212-740-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033516093OtherGHI
NY$$$$$$$$$AMedicaid