Provider Demographics
NPI:1235491689
Name:CRIMMINS, JENNIFER (MSED)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:CRIMMINS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 VANTAGE CT
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2292
Mailing Address - Country:US
Mailing Address - Phone:631-455-8842
Mailing Address - Fax:
Practice Address - Street 1:33 VANTAGE CT
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2292
Practice Address - Country:US
Practice Address - Phone:631-455-8842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist