Provider Demographics
NPI:1417518051
Name:MCALLISTER-SPECTOR, JENNIE MARIE (MS, PNP)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:MARIE
Last Name:MCALLISTER-SPECTOR
Suffix:
Gender:F
Credentials:MS, PNP
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:MARIE
Other - Last Name:MCALLISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3959 BROADWAY RM 229N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1559
Mailing Address - Country:US
Mailing Address - Phone:122-305-6575
Mailing Address - Fax:
Practice Address - Street 1:3959 BROADWAY RM 229N
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:631-241-6078
Practice Address - Fax:212-305-7834
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY740381163WP0200X
NY382981363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics