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General NPI Number Information
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NPI Number | 1194524926
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Entity Type | Individual
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Provider Name | JANNETTE MEDINA PNP
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Gender | Female
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 1055 E TREMONT AVE
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City | BRONX
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State | NY
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Zip | 10460-2306
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Country | US
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Telephone | 917-297-6842
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Fax |
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Provider Business Mailing Address
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Address Line | 76 BROOKSIDE AVE UNIT 23
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City | CHESTER
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State | NY
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Zip | 10918-7502
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Country | US
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Telephone |
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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 | F-383560
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License Number State | NY
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