Provider Demographics
NPI:1649679234
Name:SEVERE, JEANNE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:SEVERE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:SEVERE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:202 W 102ND ST
Mailing Address - Street 2:APT # 3EF
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8700
Mailing Address - Country:US
Mailing Address - Phone:917-399-8736
Mailing Address - Fax:212-316-6130
Practice Address - Street 1:202 W 102ND ST
Practice Address - Street 2:APT # 3EF
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-8700
Practice Address - Country:US
Practice Address - Phone:917-399-8736
Practice Address - Fax:212-316-6130
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003776363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant