Healthcare Provider Details

I. General information

NPI: 1588480149
Provider Name (Legal Business Name): JENNA A UHR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2024
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NASSAU DR
GREAT NECK NY
11021-2156
US

IV. Provider business mailing address

10 NASSAU DR
GREAT NECK NY
11021-2156
US

V. Phone/Fax

Practice location:
  • Phone: 516-780-1530
  • Fax:
Mailing address:
  • Phone: 516-780-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: