Healthcare Provider Details

I. General information

NPI: 1124508031
Provider Name (Legal Business Name): JENNIFER L CABANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W 38TH ST
NEW YORK NY
10018-2913
US

IV. Provider business mailing address

307 W 38TH ST FL 6
NEW YORK NY
10018-9537
US

V. Phone/Fax

Practice location:
  • Phone: 212-695-4564
  • Fax:
Mailing address:
  • Phone: 212-695-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number871704340
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: