Healthcare Provider Details

I. General information

NPI: 1861315178
Provider Name (Legal Business Name): GINA JENNINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 MONTAUK HWY
AMAGANSETT NY
11930-2110
US

IV. Provider business mailing address

40 MONROE DR
MONTAUK NY
11954-5146
US

V. Phone/Fax

Practice location:
  • Phone: 631-717-7684
  • Fax:
Mailing address:
  • Phone: 516-312-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number002706
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: