Provider Demographics
NPI:1821307091
Name:MASSI, JENNIFER J (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:J
Last Name:MASSI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 FOREST HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7647
Mailing Address - Country:US
Mailing Address - Phone:347-683-9914
Mailing Address - Fax:
Practice Address - Street 1:41 FOREST HILL RD
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7647
Practice Address - Country:US
Practice Address - Phone:347-683-9914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY623532-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse