Healthcare Provider Details

I. General information

NPI: 1770013625
Provider Name (Legal Business Name): JENNIFER MARIA GEORGE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 HAVEN AVE # B-234
NEW YORK NY
10032-2604
US

IV. Provider business mailing address

PO BOX 77
NEW YORK NY
10032-0077
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number707897
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: