Provider Demographics
NPI:1619523586
Name:KINSLEY, JACQUELINE P (MAT, TOD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:P
Last Name:KINSLEY
Suffix:
Gender:F
Credentials:MAT, TOD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 WESTCHESTER AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2500
Mailing Address - Country:US
Mailing Address - Phone:914-305-5345
Mailing Address - Fax:
Practice Address - Street 1:2975 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2518
Practice Address - Country:US
Practice Address - Phone:914-305-5345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3902355174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3902355OtherTEACHER OF THE DEAF AND HARD OF HEARING