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General NPI Number Information
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NPI Number | 1861724916
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Entity Type | Individual
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Provider Name | JEANNE ELIZABETH FENNER M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/30/2010
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Last Update Date | 01/30/2010
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Provider Practice Location Address
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Address Line | 30 MARTENSE ST #LA
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City | BROOKLYN
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State | NY
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Zip | 11226-3273
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Country | US
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Telephone | 718-857-6459
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Fax |
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Provider Business Mailing Address
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Address Line | 47 RUTLAND RD
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City | BROOKLYN
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State | NY
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Zip | 11225-5312
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Country | US
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Telephone | 718-857-6459
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 096127
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License Number State | NY
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