Provider Demographics
NPI:1184906315
Name:MCDONALD, JENNIFER LAYNE (LAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LAYNE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:43 CLINTON ST
Mailing Address - Street 2:#3
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1557
Mailing Address - Country:US
Mailing Address - Phone:845-542-3571
Mailing Address - Fax:
Practice Address - Street 1:54 AMES AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1702
Practice Address - Country:US
Practice Address - Phone:845-542-3571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00084300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist