Provider Demographics
NPI:1922544519
Name:GRACIANO, JENNIFER (MSE)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GRACIANO
Suffix:
Gender:F
Credentials:MSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 95TH AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-1313
Mailing Address - Country:US
Mailing Address - Phone:347-721-0441
Mailing Address - Fax:
Practice Address - Street 1:8620 95TH AVE
Practice Address - Street 2:APT 2
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1313
Practice Address - Country:US
Practice Address - Phone:347-721-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist