Provider Demographics
NPI:1427270123
Name:WHITTEN, JEAN ANN (PA)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:ANN
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:55 5TH AVE
Mailing Address - Street 2:STE 1902
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4301
Mailing Address - Country:US
Mailing Address - Phone:646-602-8030
Mailing Address - Fax:646-602-9154
Practice Address - Street 1:75 MAIDEN LN
Practice Address - Street 2:SUITE 1206
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4810
Practice Address - Country:US
Practice Address - Phone:212-995-6495
Practice Address - Fax:212-844-6772
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002010363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant