Provider Demographics
NPI:1679629315
Name:RATH, JENNIFER M (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:M
Last Name:RATH
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2116
Mailing Address - Country:US
Mailing Address - Phone:516-795-5339
Mailing Address - Fax:
Practice Address - Street 1:353 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 303
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4200
Practice Address - Country:US
Practice Address - Phone:631-864-3900
Practice Address - Fax:631-864-2954
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011465363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant