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General NPI Number Information
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NPI Number | 1336963990
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Entity Type | Individual
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Provider Name | JACQUELINE MARCY WENGER RDH
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Gender | Female
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 515 MADISON AVE RM 3303
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City | NEW YORK
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State | NY
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Zip | 10022-5415
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Country | US
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Telephone | 212-751-1333
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Fax |
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Provider Business Mailing Address
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Address Line | 10255 67TH DR APT LA
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City | FOREST HILLS
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State | NY
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Zip | 11375-2822
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Country | US
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Telephone | 718-208-9857
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 023692
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License Number State | NY
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