Provider Demographics
NPI:1235567736
Name:REILLY, JENGI M (FNP)
Entity Type:Individual
Prefix:
First Name:JENGI
Middle Name:M
Last Name:REILLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 RIVERSIDE DR
Mailing Address - Street 2:LOURDES BREAST CARE CENTER
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4246
Mailing Address - Country:US
Mailing Address - Phone:607-798-5111
Mailing Address - Fax:607-798-6111
Practice Address - Street 1:169 RIVERSIDE DR
Practice Address - Street 2:LOURDES BREAST CARE CENTER
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4246
Practice Address - Country:US
Practice Address - Phone:607-798-5111
Practice Address - Fax:607-798-6111
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338255-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily