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General NPI Number Information
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NPI Number | 1811350242
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Entity Type | Organization
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Legal Business Name | JENNA MEDICAL OFFICE PC
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Dates
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Enumeration Date | 04/02/2016
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 13405 ROCKAWAY BLVD
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City | SOUTH OZONE PARK
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State | NY
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Zip | 11420-3020
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Country | US
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Telephone | 718-323-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 235 E 44TH ST APT 9D
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City | NEW YORK
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State | NY
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Zip | 10017-4384
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Country | US
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Telephone | 516-721-6717
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JENNA L BUTNER
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Credential | MD
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Telephone | 516-721-6717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 270676
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License Number State | NY
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