Healthcare Provider Details

I. General information

NPI: 1851907836
Provider Name (Legal Business Name): JENNIFER SOMERVILLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 LITTLE EAST NECK RD
WEST BABYLON NY
11704-6538
US

IV. Provider business mailing address

1231 DEER PARK AVE
NORTH BABYLON NY
11703-3104
US

V. Phone/Fax

Practice location:
  • Phone: 631-968-7700
  • Fax: 631-968-7705
Mailing address:
  • Phone: 631-968-7700
  • Fax: 631-968-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346465
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408318
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: