Provider Demographics
NPI:1679506455
Name:REARDON, JENNIFER L (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:REARDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 NORTH MIDLAND AVE
Mailing Address - Street 2:WEILL CORNELL MULTIPLE SCLEROSIS CENTER AT NYACK HOSPIT
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960
Mailing Address - Country:US
Mailing Address - Phone:845-348-8880
Mailing Address - Fax:845-348-2047
Practice Address - Street 1:160 NORTH MIDLAND AVE
Practice Address - Street 2:WEILL CORNELL MULTIPLE SCLEROSIS CENTER AT NYACK HOSPIT
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960
Practice Address - Country:US
Practice Address - Phone:845-348-8880
Practice Address - Fax:845-348-2047
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF303926363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health