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General NPI Number Information
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NPI Number | 1265468243
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Entity Type | Individual
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Provider Name | LISA MICHELLE JENKINS M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 160 W 100TH ST
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City | NEW YORK
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State | NY
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Zip | 10025-5145
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Country | US
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Telephone | 464-841-2956
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Fax | 646-364-0780
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Provider Business Mailing Address
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Address Line | 160 W 100TH ST RM 226
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City | NEW YORK
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State | NY
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Zip | 10025-5145
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Country | US
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Telephone | 646-484-1295
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Fax | 646-364-0780
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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 | MA068681
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 217561
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License Number State | NY
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