Provider Demographics
NPI:1811350242
Name:JENNA MEDICAL OFFICE PC
Entity type:Organization
Organization Name:JENNA MEDICAL OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-721-6717
Mailing Address - Street 1:235 E 44TH ST APT 9D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4384
Mailing Address - Country:US
Mailing Address - Phone:516-721-6717
Mailing Address - Fax:
Practice Address - Street 1:13405 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-3020
Practice Address - Country:US
Practice Address - Phone:718-323-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-02
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207QA0401X
NY270676207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty