Provider Demographics
NPI:1457666745
Name:MARKHAM, JENNIFER (LRT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:LRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 MADISON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5201
Mailing Address - Country:US
Mailing Address - Phone:212-685-8113
Mailing Address - Fax:212-697-4541
Practice Address - Street 1:317 MADISON AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5201
Practice Address - Country:US
Practice Address - Phone:212-685-8113
Practice Address - Fax:212-697-4541
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY647317247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist