Provider Demographics
NPI:1497408702
Name:LEGORE, JENNIFER IRENE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:IRENE
Last Name:LEGORE
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 1:207 MIRIAM PKWY
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4432
Mailing Address - Country:US
Mailing Address - Phone:516-286-1903
Mailing Address - Fax:
Practice Address - Street 1:207 MIRIAM PKWY
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4432
Practice Address - Country:US
Practice Address - Phone:516-286-1903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)