Provider Demographics
NPI:1619474830
Name:KUINOV, JENNIFER HANNAH (DPM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HANNAH
Last Name:KUINOV
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 DITMAS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5204
Mailing Address - Country:US
Mailing Address - Phone:646-886-9320
Mailing Address - Fax:
Practice Address - Street 1:1001 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3750
Practice Address - Country:US
Practice Address - Phone:718-709-3925
Practice Address - Fax:718-709-3926
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN007149213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty