Provider Demographics
NPI:1518250190
Name:DUROCHER, JENNIFER B
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:DUROCHER
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 1:1200 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-8039
Mailing Address - Country:US
Mailing Address - Phone:516-850-3738
Mailing Address - Fax:
Practice Address - Street 1:1200 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-8039
Practice Address - Country:US
Practice Address - Phone:516-850-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2784551164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02908432Medicaid