Provider Demographics
NPI:1396808481
Name:MATHUR, JENNIFER A (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:MATHUR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 94TH ST
Mailing Address - Street 2:APARTMENT 806
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3903
Mailing Address - Country:US
Mailing Address - Phone:646-472-9248
Mailing Address - Fax:
Practice Address - Street 1:FIRST AVENUE AND 27TH STREET
Practice Address - Street 2:ATTENTION 19W33
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-562-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015789103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical