Healthcare Provider Details

I. General information

NPI: 1730844275
Provider Name (Legal Business Name): MS. JENNIFER E SEKULSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 OCEAN PROMENADE APT 3A
ROCKAWAY PARK NY
11694-1808
US

IV. Provider business mailing address

PO BOX 564133
COLLEGE POINT NY
11356-4133
US

V. Phone/Fax

Practice location:
  • Phone: 516-884-4658
  • Fax:
Mailing address:
  • Phone: 516-884-4658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1404939201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: