Provider Demographics
NPI:1932436946
Name:DUMORNAY, JACQUELINE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:DUMORNAY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11706 225TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1706
Mailing Address - Country:US
Mailing Address - Phone:718-712-8511
Mailing Address - Fax:718-527-5624
Practice Address - Street 1:11706 225TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1706
Practice Address - Country:US
Practice Address - Phone:718-712-8511
Practice Address - Fax:718-527-5624
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP73499363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical