Healthcare Provider Details

I. General information

NPI: 1669608931
Provider Name (Legal Business Name): ROSETTA JENKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 GERARD AVE MENTAL HEALTH CLINIC
BRONX NY
10452-8001
US

IV. Provider business mailing address

1225 GERARD AVE MENTAL HEALTH CLINIC
BRONX NY
10452-8001
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-2883
  • Fax: 718-960-2948
Mailing address:
  • Phone: 718-960-2883
  • Fax: 718-960-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number266955
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: