Provider Demographics
NPI:1760098438
Name:MA, JENNY
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:HOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25121 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1354
Mailing Address - Country:US
Mailing Address - Phone:917-701-2211
Mailing Address - Fax:
Practice Address - Street 1:25121 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1354
Practice Address - Country:US
Practice Address - Phone:917-701-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic
No156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant