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General NPI Number Information
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NPI Number | 1104052778
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Entity Type | Individual
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Provider Name | JACLYN MCKINSTRY M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 403 E 34TH ST
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City | NEW YORK
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State | NY
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Zip | 10016-4972
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Country | US
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Telephone | 212-263-8475
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Fax |
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Provider Business Mailing Address
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Address Line | 1575 TREMONT ST APT #209
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City | ROXBURY CROSSING
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State | MA
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Zip | 02120-1677
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Country | US
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Telephone | 856-952-9206
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 241114
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 277037
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 277037
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License Number State | NY
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