Healthcare Provider Details

I. General information

NPI: 1073601936
Provider Name (Legal Business Name): MARILENA A. JENNINGS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARILENA D. JENNINGS M.D.

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 FULTON AVE FITH FLOOR CHILD AND ADOLESCENT PSYCHIATRY SERVICE
BRONX NY
10456-3402
US

IV. Provider business mailing address

2926 LASALLE AVE FL-1
BRONX NY
10461-5906
US

V. Phone/Fax

Practice location:
  • Phone: 718-466-7281
  • Fax: 718-466-7288
Mailing address:
  • Phone: 347-398-9179
  • Fax: 347-398-9179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number225942-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: