Provider Demographics
NPI:1780828319
Name:KENASTON, JESSICA (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KENASTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:68 S SERVICE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2354
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:66 POWERHOUSE RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1372
Practice Address - Country:US
Practice Address - Phone:516-945-3000
Practice Address - Fax:516-945-3131
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY241545207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology