Healthcare Provider Details

I. General information

NPI: 1891120572
Provider Name (Legal Business Name): JENNIFER JANE ALFANO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E MAIN ST
SMITHTOWN NY
11787-2807
US

IV. Provider business mailing address

1010 NORTHERN BLVD STE 328
GREAT NECK NY
11021-5329
US

V. Phone/Fax

Practice location:
  • Phone: 631-265-5858
  • Fax: 631-265-5756
Mailing address:
  • Phone: 516-233-2484
  • Fax: 516-304-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number306517
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: