Provider Demographics
NPI:1518220193
Name:JENEI, ANDREA ERIKA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ERIKA
Last Name:JENEI
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 1:577 GRAND STREET
Mailing Address - Street 2:APT # 1607
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-3600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:577 GRAND ST
Practice Address - Street 2:APT #1607
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4383
Practice Address - Country:US
Practice Address - Phone:917-664-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY503454111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist