Provider Demographics
NPI:1720867716
Name:DREXEL, JANE P
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:P
Last Name:DREXEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 HYLAN BLVD STE 9B1
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1945
Mailing Address - Country:US
Mailing Address - Phone:917-397-8947
Mailing Address - Fax:929-226-6026
Practice Address - Street 1:1250 HYLAN BLVD STE 9B1
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1945
Practice Address - Country:US
Practice Address - Phone:917-397-8947
Practice Address - Fax:929-226-6026
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist