Provider Demographics
NPI:1790776136
Name:KRESGE, JENNIFER ALISON (PA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ALISON
Last Name:KRESGE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BELLEVUE WOMEN'S CENTER, 2210 TROY-SCHENECTADY ROAD
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309
Mailing Address - Country:US
Mailing Address - Phone:518-220-9413
Mailing Address - Fax:518-220-9417
Practice Address - Street 1:BELLUVUE WOMEN'S CENTER
Practice Address - Street 2:2210 TROY-SCHENECTADY ROAD
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309
Practice Address - Country:US
Practice Address - Phone:518-220-9413
Practice Address - Fax:518-220-9417
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006408363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00117764OtherRR MEDICARE
NY02509199Medicaid
NY02509199Medicaid
NYPA0077Medicare ID - Type Unspecified