Provider Demographics
NPI:1467862243
Name:LEYENDECKER, JENNIFERC
Entity Type:Individual
Prefix:MRS
First Name:JENNIFERC
Middle Name:
Last Name:LEYENDECKER
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 1:67 ADAIR CT
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1006
Mailing Address - Country:US
Mailing Address - Phone:516-599-5230
Mailing Address - Fax:
Practice Address - Street 1:67 ADAIR CT
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1006
Practice Address - Country:US
Practice Address - Phone:516-599-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY585445051252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency