Provider Demographics
NPI:1851636757
Name:ALLENDE, JENNIFER ELAINE (MPH, MSED)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELAINE
Last Name:ALLENDE
Suffix:
Gender:F
Credentials:MPH, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 BRONX RIVER RD APT A21
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-6972
Mailing Address - Country:US
Mailing Address - Phone:914-217-7754
Mailing Address - Fax:914-410-3750
Practice Address - Street 1:770 BRONX RIVER RD APT A21
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-6972
Practice Address - Country:US
Practice Address - Phone:914-217-7754
Practice Address - Fax:914-410-3750
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1181326390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program