Healthcare Provider Details

I. General information

NPI: 1912349192
Provider Name (Legal Business Name): JENNIFER L MACINTYRE LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L SABATINO LCGC

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN STANTON RD SUITE 2200
NEWARK DE
19713-2055
US

IV. Provider business mailing address

4701 OGLETOWN STANTON RD SUITE 2200
NEWARK DE
19713-2055
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4593
  • Fax: 302-623-4845
Mailing address:
  • Phone: 302-623-4593
  • Fax: 302-623-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberCG-0000050
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: