=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073339065
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAZMINE KATHERINE ENCALADA PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2024
-----------------------------------------------------
Last Update Date | 07/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 GUSTAVE L LEVY PL FL 12
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10029-6574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-241-6500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3216 106TH ST FL 1
-----------------------------------------------------
City | EAST ELMHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11369-2520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-461-6936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 033820
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------