Provider Demographics
NPI:1669242442
Name:WENG, JENNY Z (PA-C)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:Z
Last Name:WENG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1090
Mailing Address - Country:US
Mailing Address - Phone:203-371-7999
Mailing Address - Fax:
Practice Address - Street 1:1 WALLACE BASHAW WAY
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3875
Practice Address - Country:US
Practice Address - Phone:978-997-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1217346363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant