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General NPI Number Information
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NPI Number | 1992042840
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Entity Type | Individual
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Provider Name | JENNA ELIZABETH HAFNER PA- C, DPT
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Gender | Female
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Dates
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Enumeration Date | 01/12/2013
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 3757 CARMAN RD STE 100
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City | SCHENECTADY
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State | NY
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Zip | 12303-5438
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Country | US
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Telephone | 518-355-7063
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Fax | 518-357-0646
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Provider Business Mailing Address
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Address Line | 711 TROY SCHENECTADY RD STE 203
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City | LATHAM
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State | NY
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Zip | 12110-2461
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Country | US
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Telephone | 518-782-3700
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Fax | 518-782-3799
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110004150
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 019274-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 019274
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License Number State | NY
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