Healthcare Provider Details

I. General information

NPI: 1578958880
Provider Name (Legal Business Name): JENNIFER LYNN MCCAIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN HORNE D.O.

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE 5TH FL ADMIN
BRONX NY
10457-7606
US

IV. Provider business mailing address

1650 GRAND CONCOURSE 5TH FL ADMIN
BRONX NY
10457-7606
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-8383
  • Fax: 718-239-8360
Mailing address:
  • Phone: 718-239-8383
  • Fax: 718-239-8360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number312658
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: