Provider Demographics
NPI:1255197257
Name:REIDINGER, JENNIFER JOHANNA
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JOHANNA
Last Name:REIDINGER
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 1:336 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4612
Mailing Address - Country:US
Mailing Address - Phone:347-938-0440
Mailing Address - Fax:
Practice Address - Street 1:220 HEBERTON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1415
Practice Address - Country:US
Practice Address - Phone:718-448-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility