Provider Demographics
NPI:1831446160
Name:REINHART, JENNIFER G (PA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:G
Last Name:REINHART
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2791 RICHMOND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5882
Mailing Address - Country:US
Mailing Address - Phone:718-816-6440
Mailing Address - Fax:
Practice Address - Street 1:1050 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3627
Practice Address - Country:US
Practice Address - Phone:718-816-6440
Practice Address - Fax:718-816-3642
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant