Healthcare Provider Details

I. General information

NPI: 1851519961
Provider Name (Legal Business Name): WENDY OLIVIA HARRIS-JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JEROME AVE
BRONX NY
10467-1052
US

IV. Provider business mailing address

50 HAMPTON CT
MIDDLETOWN NY
10941-1610
US

V. Phone/Fax

Practice location:
  • Phone: 718-881-7600
  • Fax:
Mailing address:
  • Phone: 845-692-5821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: