Provider Demographics
NPI:1942255427
Name:SO, JENNY (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:SO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:MOUNT KISCO MEDICAL GROUP PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-962-0527
Practice Address - Street 1:MOUNT KISCO MEDICAL GROUP PC
Practice Address - Street 2:1825 COMMERCE STREET
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4432
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:914-962-0527
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-08-06
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Provider Licenses
StateLicense IDTaxonomies
NY201297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01744985Medicaid
NY01744985Medicaid
NY86Y7306761Medicare PIN