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General NPI Number Information
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NPI Number | 1801484951
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Entity Type | Individual
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Provider Name | JENNA DENNINE PEART NP
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Gender | Female
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 4771 HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10312-6315
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Country | US
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Telephone | 718-948-8200
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Fax | 718-317-4111
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Provider Business Mailing Address
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Address Line | 55 WATER ST FL 2
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City | NEW YORK
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State | NY
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Zip | 10041-0010
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Country | US
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Telephone | 646-680-2888
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Fax | 516-542-5556
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 345554
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 345554
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License Number State | NY
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