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General NPI Number Information
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NPI Number | 1851494165
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Entity Type | Individual
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Provider Name | MARY L. JENSIS- CARLSON D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 03/26/2009
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Provider Practice Location Address
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Address Line | 637 WILLIS AVE SUITE A
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City | WILLISTON PARK
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State | NY
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Zip | 11596-1154
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Country | US
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Telephone | 516-248-8188
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Fax |
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Provider Business Mailing Address
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Address Line | 7401 SHORE RD APT 1H
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City | BROOKLYN
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State | NY
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Zip | 11209-1953
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Country | US
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Telephone | 718-833-0550
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N005090
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N005090
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License Number State | NY
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