Provider Demographics
NPI:1528022001
Name:KALLIO, JENNIFER L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:KALLIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HARWOOD CT STE 217
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4120
Mailing Address - Country:US
Mailing Address - Phone:914-472-4100
Mailing Address - Fax:
Practice Address - Street 1:14 HARWOOD CT STE 217
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4120
Practice Address - Country:US
Practice Address - Phone:914-472-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103446363AM0700X
NY019584-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9103446OtherMEDICAL LICENSE
FLP01160388OtherRAILROAD MEDICARE
FLP1024097OtherFREEDOM HEALTH CARE
FLP62654OtherOPTIMUM
FLP62654OtherOPTIMUM