Provider Demographics
NPI:1699358705
Name:CISLAK, JENNA RENE
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:RENE
Last Name:CISLAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 KNOLLWOOD RD STE 108
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-1916
Mailing Address - Country:US
Mailing Address - Phone:914-949-8501
Mailing Address - Fax:914-949-8502
Practice Address - Street 1:399 KNOLLWOOD RD STE 108
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-1916
Practice Address - Country:US
Practice Address - Phone:914-949-8501
Practice Address - Fax:914-949-8502
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic