Provider Demographics
NPI:1023886041
Name:KISH, JENNIFER (MHS,PA (ASCP))
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:KISH
Suffix:
Gender:F
Credentials:MHS,PA (ASCP)
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS,PA (ASCP)
Mailing Address - Street 1:226 NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-3419
Mailing Address - Country:US
Mailing Address - Phone:617-308-1568
Mailing Address - Fax:
Practice Address - Street 1:100 PARK ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4447
Practice Address - Country:US
Practice Address - Phone:518-926-3836
Practice Address - Fax:518-926-3857
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000405-01207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology