Healthcare Provider Details

I. General information

NPI: 1295070035
Provider Name (Legal Business Name): JESSICA SENGE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E 161ST ST
BRONX NY
10451-3543
US

IV. Provider business mailing address

4012 80TH ST
ELMHURST NY
11373-1234
US

V. Phone/Fax

Practice location:
  • Phone: 718-886-9000
  • Fax:
Mailing address:
  • Phone: 718-886-9000
  • Fax: 718-961-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number015068
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: