Provider Demographics
NPI:1669439980
Name:BOVE, JENNIFER LYNN (DPM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:BOVE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:BOVE MAKUCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:1528 HOMECOURT
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-1226
Mailing Address - Country:US
Mailing Address - Phone:716-937-8834
Mailing Address - Fax:
Practice Address - Street 1:1045 WEHRLE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7723
Practice Address - Country:US
Practice Address - Phone:716-688-1464
Practice Address - Fax:716-688-1465
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005789213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02286102Medicaid
U89051Medicare UPIN
NY02286102Medicaid