Provider Demographics
NPI:1275759052
Name:SERVENTI, JENNIFER NOEL (PA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NOEL
Last Name:SERVENTI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 704
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-276-3971
Mailing Address - Fax:585-276-2463
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 704
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-276-3971
Practice Address - Fax:585-276-2463
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6688363A00000X
NY006688-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA2073OtherPTAN