Healthcare Provider Details

I. General information

NPI: 1801724968
Provider Name (Legal Business Name): AIJIA FENNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 E 4TH ST
NEW YORK NY
10003-9001
US

IV. Provider business mailing address

40 WATERSIDE PLZ APT 12G
NEW YORK NY
10010-2637
US

V. Phone/Fax

Practice location:
  • Phone: 646-749-6691
  • Fax:
Mailing address:
  • Phone: 646-749-6691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: