Provider Demographics
NPI:1912902701
Name:VINCENT, JENNIFER C (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2900 WESTCHESTER AVE
Mailing Address - Street 2:STE 307
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2551
Mailing Address - Country:US
Mailing Address - Phone:914-249-7000
Mailing Address - Fax:914-249-7032
Practice Address - Street 1:1500 ASTOR AVE
Practice Address - Street 2:LBBY 1E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5900
Practice Address - Country:US
Practice Address - Phone:718-652-0003
Practice Address - Fax:718-652-0815
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY007190363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYOF5761Medicare ID - Type Unspecified
NYS99793Medicare UPIN