Provider Demographics
NPI:1376893107
Name:SECCAFICO, JENNIFER A
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:A
Last Name:SECCAFICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 ILYSSA WAY
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1388
Mailing Address - Country:US
Mailing Address - Phone:718-605-6814
Mailing Address - Fax:
Practice Address - Street 1:448 ILYSSA WAY
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1388
Practice Address - Country:US
Practice Address - Phone:718-605-6814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311243-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse