=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679506455
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER L REARDON NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 11/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 NORTH MIDLAND AVE WEILL CORNELL MULTIPLE SCLEROSIS CENTER AT NYACK HOSPIT
-----------------------------------------------------
City | NYACK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-348-8880
-----------------------------------------------------
Fax | 845-348-2047
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 NORTH MIDLAND AVE WEILL CORNELL MULTIPLE SCLEROSIS CENTER AT NYACK HOSPIT
-----------------------------------------------------
City | NYACK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-348-8880
-----------------------------------------------------
Fax | 845-348-2047
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | F303926
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------