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General NPI Number Information
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NPI Number | 1043300221
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Entity Type | Individual
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Provider Name | JESSICA G DAVIS MD
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 428 E 72ND ST
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City | NEW YORK
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State | NY
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Zip | 10021-4635
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Country | US
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Telephone | 212-746-1496
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Fax | 212-746-8893
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Provider Business Mailing Address
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Address Line | 428 E 72ND ST RM 100
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City | NEW YORK
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State | NY
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Zip | 10021-4635
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Country | US
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Telephone | 212-746-0373
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Fax | 212-746-7481
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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 | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | 089706
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License Number State | NY
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