Healthcare Provider Details

I. General information

NPI: 1790776136
Provider Name (Legal Business Name): JENNIFER ALISON KRESGE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BELLUVUE WOMEN'S CENTER 2210 TROY-SCHENECTADY ROAD
NISKAYUNA NY
12309
US

IV. Provider business mailing address

BELLEVUE WOMEN'S CENTER, 2210 TROY-SCHENECTADY ROAD
NISKAYUNA NY
12309
US

V. Phone/Fax

Practice location:
  • Phone: 518-220-9413
  • Fax: 518-220-9417
Mailing address:
  • Phone: 518-220-9413
  • Fax: 518-220-9417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006408
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: