Healthcare Provider Details

I. General information

NPI: 1558164145
Provider Name (Legal Business Name): JENNIE DRAZIN PA-C
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2025
Last Update Date: 04/19/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 COMMONWEALTH AVE
BOSTON MA
02215-1001
US

IV. Provider business mailing address

1055 COMMONWEALTH AVE
BOSTON MA
02215-1001
US

V. Phone/Fax

Practice location:
  • Phone: 617-295-7235
  • Fax: 844-791-0108
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: