Healthcare Provider Details

I. General information

NPI: 1699037150
Provider Name (Legal Business Name): JENNIFER MARIE BJORKLUND MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 EXECUTIVE DR SUITE LL-105/108
PLAINVIEW NY
11803-1718
US

IV. Provider business mailing address

PO BOX 743
SAINT JAMES NY
11780-0743
US

V. Phone/Fax

Practice location:
  • Phone: 516-576-2040
  • Fax:
Mailing address:
  • Phone: 516-672-4236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: