Healthcare Provider Details

I. General information

NPI: 1366756256
Provider Name (Legal Business Name): JENNIFER MCGETRICK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 CHARLTON RD
BALLSTON LAKE NY
12019-2547
US

IV. Provider business mailing address

112 CHARLTON RD
BALLSTON LAKE NY
12019-2547
US

V. Phone/Fax

Practice location:
  • Phone: 518-399-7723
  • Fax: 518-399-6428
Mailing address:
  • Phone: 518-399-7723
  • Fax: 518-399-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number014061
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: