Healthcare Provider Details

I. General information

NPI: 1467208652
Provider Name (Legal Business Name): JENNA DIAHANN GARRETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE
NEW YORK NY
10029-7491
US

IV. Provider business mailing address

3578 CANAL AVE
BROOKLYN NY
11224-1686
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-8097
  • Fax:
Mailing address:
  • Phone: 718-715-6443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: