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General NPI Number Information
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NPI Number | 1043017130
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Entity Type | Individual
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Provider Name | JENNA EIVAZI
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Gender | Female
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 1530 FRONT ST
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City | EAST MEADOW
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State | NY
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Zip | 11554-2265
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Country | US
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Telephone | 516-324-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 343 LEXINGTON AVE
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-1320
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Country | US
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Telephone | 516-477-7811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 004927
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License Number State | NY
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