Provider Demographics
NPI:1801035084
Name:MAIS, JENNIFER CAREN (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:CAREN
Last Name:MAIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 EASTCHESTER RD
Mailing Address - Street 2:2ND LEVEL, SUITE A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2252
Mailing Address - Country:US
Mailing Address - Phone:201-927-4016
Mailing Address - Fax:
Practice Address - Street 1:FIRST AVENUE AT E. 16TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-420-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013101-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant