Provider Demographics
NPI:1396065025
Name:SMITH, JEANNINE LINDA (PA)
Entity type:Individual
Prefix:MRS
First Name:JEANNINE
Middle Name:LINDA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1300 FRANKLIN AVE STE 3A
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1886
Mailing Address - Country:US
Mailing Address - Phone:516-492-3100
Mailing Address - Fax:516-492-3097
Practice Address - Street 1:216 1ST ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3901
Practice Address - Country:US
Practice Address - Phone:516-741-0570
Practice Address - Fax:516-741-8276
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2014-05-13
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Provider Licenses
StateLicense IDTaxonomies
NY010757363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant