Provider Demographics
NPI:1356770481
Name:MANFREDONIA, JENNIFER MARIE (FNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:MANFREDONIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N. MIDDLETOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965
Mailing Address - Country:US
Mailing Address - Phone:845-735-4814
Mailing Address - Fax:845-735-4815
Practice Address - Street 1:200 N. MIDDLETOWN ROAD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965
Practice Address - Country:US
Practice Address - Phone:845-735-4814
Practice Address - Fax:845-735-4815
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily