Provider Demographics
NPI:1518996784
Name:PATUTO, JENNIFER (CNM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PATUTO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2407
Mailing Address - Country:US
Mailing Address - Phone:845-353-1441
Mailing Address - Fax:845-353-1987
Practice Address - Street 1:258 HIGH AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2407
Practice Address - Country:US
Practice Address - Phone:845-353-1441
Practice Address - Fax:845-353-1987
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001188-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY389094OtherMVP #
NY6C0008OtherHEALTHNET #
NY000000112683OtherGHI HMO #
NY7546828OtherAETNA PPO #
NY0126665OtherGHI PPO #
NY02884646Medicaid
NY1320071OtherAETNA HMO #