Provider Demographics
NPI:1275950990
Name:JHINGOOR, RENNIE
Entity Type:Individual
Prefix:
First Name:RENNIE
Middle Name:
Last Name:JHINGOOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 N MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2057
Mailing Address - Country:US
Mailing Address - Phone:845-735-0223
Mailing Address - Fax:845-735-5673
Practice Address - Street 1:169 N MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2057
Practice Address - Country:US
Practice Address - Phone:845-735-0223
Practice Address - Fax:845-735-5673
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004929-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist