Healthcare Provider Details

I. General information

NPI: 1669420550
Provider Name (Legal Business Name): JENNIFER ANN FRONTERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55TH ST
BROOKLYN NY
11220-2508
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL BOX 1136B
NEW YORK NY
10029-6574
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-6689
  • Fax:
Mailing address:
  • Phone: 212-241-0002
  • Fax: 212-831-3250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number227233
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number227233
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: