Healthcare Provider Details

I. General information

NPI: 1639290885
Provider Name (Legal Business Name): JENNY N ESKRETT LIC. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 BROADWAY SUITE 1105
NEW YORK NY
10003-4703
US

IV. Provider business mailing address

180 HALSTEAD AVE 3A
HARRISON NY
10528-3632
US

V. Phone/Fax

Practice location:
  • Phone: 212-614-8800
  • Fax:
Mailing address:
  • Phone: 914-315-1051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number221448
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002445
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: