Provider Demographics
NPI:1336401371
Name:SLANE, JENNIFER KATHERINE (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KATHERINE
Last Name:SLANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CHARLES LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3632
Mailing Address - Country:US
Mailing Address - Phone:516-248-3737
Mailing Address - Fax:
Practice Address - Street 1:106 CHARLES LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3632
Practice Address - Country:US
Practice Address - Phone:516-248-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269052207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology