Healthcare Provider Details

I. General information

NPI: 1578377966
Provider Name (Legal Business Name): JENNIFER N COLON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date: 12/22/2025
Reactivation Date: 09/16/2026

III. Provider practice location address

110 BI COUNTY BLVD
FARMINGDALE NY
11735-3943
US

IV. Provider business mailing address

110 BI COUNTY BLVD
FARMINGDALE NY
11735-3943
US

V. Phone/Fax

Practice location:
  • Phone: 917-000-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number346190
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: