Provider Demographics
NPI:1649366626
Name:MCNAMARA, JENNIFER (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MCNAMARA
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 1:255 LAFAYETTE AVE
Mailing Address - Street 2:CARDIOLOGY DEPARTMENT
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4812
Mailing Address - Country:US
Mailing Address - Phone:845-368-5195
Mailing Address - Fax:845-368-8250
Practice Address - Street 1:255 LAFAYETTE AVE
Practice Address - Street 2:CARDIOLOGY DEPARTMENT
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4812
Practice Address - Country:US
Practice Address - Phone:845-368-5195
Practice Address - Fax:845-368-8250
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333976363LF0000X
NY476742163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1591G1Medicare ID - Type Unspecified
NYQ65792Medicare UPIN