Provider Demographics
NPI:1447397435
Name:FREEMAN, JENNIFER (MSED)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6627
Mailing Address - Country:US
Mailing Address - Phone:631-455-0142
Mailing Address - Fax:
Practice Address - Street 1:2300 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6627
Practice Address - Country:US
Practice Address - Phone:631-455-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist