Provider Demographics
NPI:1639491509
Name:DEJESUS, JENNY (NP CDCES)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:DEJESUS
Suffix:
Gender:F
Credentials:NP CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 WILLIAM ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-5358
Mailing Address - Country:US
Mailing Address - Phone:646-962-5665
Mailing Address - Fax:917-797-8564
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:BAKER 20
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY533916163WD0400X
NYF305705363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator