Provider Demographics
NPI:1851005946
Name:FIDDLER, JENNIE (CAT)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:FIDDLER
Suffix:
Gender:F
Credentials:CAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:113 GLEN COVE AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-3438
Mailing Address - Country:US
Mailing Address - Phone:516-676-2388
Mailing Address - Fax:516-759-5259
Practice Address - Street 1:113 GLEN COVE AVE
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3438
Practice Address - Country:US
Practice Address - Phone:516-676-2388
Practice Address - Fax:516-759-5259
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist