MEDICARE: JENNA ROSE LAURIA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	085009954	IL
2	363A00000X	Physician Assistant	25MP00499800	NJ
3	363A00000X	Physician Assistant	65700	CA
4	363A00000X	Physician Assistant	019495	NY

General Provider Information

NPI Number	:	1588022198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA ROSE LAURIA PA

Provider Business Mailing Address
First Line	:	272 GIFFORDS LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-1620
Country	:	US
Telephone Number	:	718-772-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 BARD AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-1664
Country	:	US
Telephone Number	:	718-818-2995
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2016
Last Update Date	:	05/05/2026

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Directions to “ JENNA ROSE LAURIA PA” Practice Location

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