Healthcare Provider Details

I. General information

NPI: 1124338066
Provider Name (Legal Business Name): JESSICA TROY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E POST RD 4I
WHITE PLAINS NY
10601-4607
US

IV. Provider business mailing address

41 E POST RD APT 213
WHITE PLAINS NY
10601-4607
US

V. Phone/Fax

Practice location:
  • Phone: 914-981-2655
  • Fax:
Mailing address:
  • Phone: 914-681-2557
  • Fax: 914-681-2839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number002440
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number019300
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: