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General NPI Number Information
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NPI Number | 1922116045
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Entity Type | Individual
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Provider Name | JEANNETTE ELIZABETH DRISCOLL PA
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Gender | Female
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 355 BARD AVE RUMC EMERGENCY DEPARTMENT
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City | STATEN ISLAND
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State | NY
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Zip | 10310-1664
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Country | US
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Telephone | 718-306-4023
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 CLOVE RD APT 4E
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City | STATEN ISLAND
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State | NY
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Zip | 10301-3648
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Country | US
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Telephone | 718-306-4023
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 010543
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License Number State | NY
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