Provider Demographics
NPI:1942862040
Name:BAYER, JENNIFER L
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:BAYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CRAWFORD CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1502
Mailing Address - Country:US
Mailing Address - Phone:631-352-8245
Mailing Address - Fax:
Practice Address - Street 1:11821 QUEENS BLVD STE 612
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7206
Practice Address - Country:US
Practice Address - Phone:631-352-8245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency