Provider Demographics
NPI:1013674928
Name:LEBENTAL, JESSICA KORASADOWICZ (FNP DNP)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:KORASADOWICZ
Last Name:LEBENTAL
Suffix:
Gender:F
Credentials:FNP DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PARK PL APT 55B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-2576
Mailing Address - Country:US
Mailing Address - Phone:862-432-5864
Mailing Address - Fax:
Practice Address - Street 1:900 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4157
Practice Address - Country:US
Practice Address - Phone:212-392-1075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-27
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF347688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily