Provider Demographics
NPI:1295733863
Name:CHRISTNER, JENNIFER GOLD (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GOLD
Last Name:CHRISTNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2342
Mailing Address - Country:US
Mailing Address - Phone:315-464-5187
Mailing Address - Fax:315-464-5188
Practice Address - Street 1:90 PRESIDENTIAL PLZ
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2240
Practice Address - Country:US
Practice Address - Phone:315-464-5800
Practice Address - Fax:315-464-2030
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074060208000000X
MI4301065724208000000X
NY266352208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03494406Medicaid
OH2076766Medicaid
OH2076766Medicaid
NY03494406Medicaid
G81039Medicare UPIN
NYJ400080133Medicare PIN