Provider Demographics
NPI:1578958880
Name:MCCAIN, JENNIFER LYNN (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:MCCAIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:HORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1650 GRAND CONCOURSE
Mailing Address - Street 2:5TH FL ADMIN
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7606
Mailing Address - Country:US
Mailing Address - Phone:718-239-8383
Mailing Address - Fax:718-239-8360
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:5TH FL ADMIN
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:718-239-8383
Practice Address - Fax:718-239-8360
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3126582080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine