Provider Demographics
NPI:1952557522
Name:JENNINGS, JENNIFER STEPHANIE (DNP)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:STEPHANIE
Last Name:JENNINGS
Suffix:
Gender:
Credentials:DNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JENNINGS
Other - Last Name:D'ORAZIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:808 COLUMBUS AVE
Mailing Address - Street 2:APT. 17E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:917-405-0775
Mailing Address - Fax:616-918-6263
Practice Address - Street 1:350 CENTRAL PARK WEST
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:646-666-0032
Practice Address - Fax:646-918-6283
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036066363LP0808X
NYF4011421363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02952812Medicaid