Healthcare Provider Details

I. General information

NPI: 1952691412
Provider Name (Legal Business Name): JENNIFER TEMPLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DEERINGWOOD LN
BABYLON NY
11702-4213
US

IV. Provider business mailing address

2 DEERINGWOOD LN
BABYLON NY
11702-4213
US

V. Phone/Fax

Practice location:
  • Phone: 631-422-4003
  • Fax: 631-539-6516
Mailing address:
  • Phone: 631-422-4003
  • Fax: 631-539-6516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number516533
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: