Provider Demographics
NPI:1922052612
Name:SOSNOWSKI, JENNIFER J (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:SOSNOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17787 N PERIMETER DR
Mailing Address - Street 2:SUITE A115
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5454
Mailing Address - Country:US
Mailing Address - Phone:480-588-7787
Mailing Address - Fax:480-588-5121
Practice Address - Street 1:17787 N PERIMETER DR
Practice Address - Street 2:SUITE A115
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5454
Practice Address - Country:US
Practice Address - Phone:480-588-7787
Practice Address - Fax:480-588-5121
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ25789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI19220521612-02Medicaid
HI0000275578OtherHMSA
HI0000275578OtherHMSA
HIH103567Medicare PIN