Healthcare Provider Details

I. General information

NPI: 1033310495
Provider Name (Legal Business Name): JENNIFER E DUROCHER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER E SECKO PA

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NOTT ST DEPARTMENT OF EMERGENCY
SCHENECTADY NY
12308-2425
US

IV. Provider business mailing address

1462 ERIE BLVD ATTN: THE MEDICAL GROUP
SCHENECTADY NY
12305-1026
US

V. Phone/Fax

Practice location:
  • Phone: 518-243-4121
  • Fax:
Mailing address:
  • Phone: 518-243-1020
  • Fax: 518-243-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011935
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: