Healthcare Provider Details

I. General information

NPI: 1265559637
Provider Name (Legal Business Name): KAREN JEFFERSON RPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 E 149TH ST HUB 3
BRONX NY
10455-3901
US

IV. Provider business mailing address

1500 WATERS PL BLDG 102, WARD 20, FLOOR 6
BRONX NY
10461-2723
US

V. Phone/Fax

Practice location:
  • Phone: 718-665-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number005314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: