Provider Demographics
NPI:1932176542
Name:SCHOLNICK, JENNA M (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:M
Last Name:SCHOLNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E 161ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3535
Mailing Address - Country:US
Mailing Address - Phone:718-579-2500
Mailing Address - Fax:718-579-2599
Practice Address - Street 1:305 E 161ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3535
Practice Address - Country:US
Practice Address - Phone:718-579-2500
Practice Address - Fax:718-579-2599
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226372208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02567628Medicaid
NY02567628Medicaid
NY6B9341Medicare ID - Type Unspecified