Healthcare Provider Details

I. General information

NPI: 1003386178
Provider Name (Legal Business Name): JENNA SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 17TH ST
NEW YORK NY
10003-3804
US

IV. Provider business mailing address

30 ETON RD
THORNWOOD NY
10594-2224
US

V. Phone/Fax

Practice location:
  • Phone: 212-598-6000
  • Fax:
Mailing address:
  • Phone: 914-437-1153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number023132-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: