Provider Demographics
NPI:1407247125
Name:STUEBER, JENNA DALE
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:DALE
Last Name:STUEBER
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 1:510 MAIN ST APT 1320
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0103
Mailing Address - Country:US
Mailing Address - Phone:917-771-0712
Mailing Address - Fax:718-388-3820
Practice Address - Street 1:243 S 2ND ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-5402
Practice Address - Country:US
Practice Address - Phone:718-388-3433
Practice Address - Fax:718-388-3820
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker