Healthcare Provider Details

I. General information

NPI: 1669073045
Provider Name (Legal Business Name): JENNIPHER SARWAR BHATTI CASE MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIPHER SARWAR BHATTI CASE MANAGER

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 03/16/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19-20 149TH STREET #R WHITESTONE
WHITESTONE NY
11357
US

IV. Provider business mailing address

4 LORRAINE AVE
MOUNT VERNON NY
10553-1222
US

V. Phone/Fax

Practice location:
  • Phone: 516-780-0770
  • Fax:
Mailing address:
  • Phone: 914-663-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: