Provider Demographics
NPI:1184989113
Name:NEW, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:NEW
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 1:525 W 235TH ST
Mailing Address - Street 2:APT 2-C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 W 235TH ST
Practice Address - Street 2:APT 2-C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1738
Practice Address - Country:US
Practice Address - Phone:917-747-4991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist