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General NPI Number Information
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NPI Number | 1073601936
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Entity Type | Individual
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Provider Name | MARILENA A. JENNINGS M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 1276 FULTON AVE FITH FLOOR CHILD AND ADOLESCENT PSYCHIATRY SERVICE
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City | BRONX
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State | NY
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Zip | 10456-3402
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Country | US
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Telephone | 718-466-7281
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Fax | 718-466-7288
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Provider Business Mailing Address
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Address Line | 2926 LASALLE AVE FL-1
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City | BRONX
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State | NY
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Zip | 10461-5906
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Country | US
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Telephone | 347-398-9179
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Fax | 347-398-9179
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 225942-1
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License Number State | NY
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