Provider Demographics
NPI:1245734920
Name:JARVIS, CASEY ALEXANDRA (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:ALEXANDRA
Last Name:JARVIS
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 1:1554 NORTHERN BLVD FL 5
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3054
Mailing Address - Country:US
Mailing Address - Phone:516-390-9242
Mailing Address - Fax:
Practice Address - Street 1:1554 NORTHERN BLVD FL 5
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3054
Practice Address - Country:US
Practice Address - Phone:516-390-9242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY318309207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program