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NPI Code Detail

MEDICARE: JENNY ROSS

MEDICARE: JENNY ROSS
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician036.142885IL
2207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianMD457159PA
3207ZP0102XAnatomic Pathology & Clinical Pathology Physician291912NY

General Provider Information

NPI Number : 1750640769
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNY ROSS
Provider Business Mailing Address
First Line : 62 BRIGHTON 2ND PL PH B
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-7055
Country : US
Telephone Number : 540-520-9081
Fax Number :
Provider Business Practice Location Address
First Line : 680 N LAKE SHORE DR STE 1000
Second Line :
City : CHICAGO
State : IL
Zip : 60611-8709
Country : US
Telephone Number : 312-695-9797
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2012
Last Update Date : 03/20/2023

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Directions to “ JENNY ROSS ” Practice Location

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