Provider Demographics
NPI:1285000612
Name:BANAAG, JENNIFER PORRAS (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:PORRAS
Last Name:BANAAG
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 TUERS AVE APT 3L
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3230
Mailing Address - Country:US
Mailing Address - Phone:201-912-9932
Mailing Address - Fax:
Practice Address - Street 1:2811 QUEENS PLZ N # 5THFLOOR
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4008
Practice Address - Country:US
Practice Address - Phone:718-391-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY670678163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse