Healthcare Provider Details

I. General information

NPI: 1710484498
Provider Name (Legal Business Name): JENNIFER FLORES KASWICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODS RD
VALHALLA NY
10595-1530
US

IV. Provider business mailing address

515 W 38TH ST APT PH1D
NEW YORK NY
10018-1190
US

V. Phone/Fax

Practice location:
  • Phone: 310-869-8017
  • Fax:
Mailing address:
  • Phone: 310-869-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number310558
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number310558
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: