Healthcare Provider Details

I. General information

NPI: 1902113640
Provider Name (Legal Business Name): MISS JEANNINE HOBBES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W 103RD ST
NEW YORK NY
10025-4434
US

IV. Provider business mailing address

400 1ST AVE 7TH FLOOR
NEW YORK NY
10010-4004
US

V. Phone/Fax

Practice location:
  • Phone: 917-256-4259
  • Fax:
Mailing address:
  • Phone: 917-256-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number714341961
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: