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NPI Code Detail

MEDICARE: JENNIFER STOREY PA

MEDICARE: JENNIFER STOREY PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant010587NY

General Provider Information

NPI Number : 1083653984
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER STOREY PA
Provider Business Mailing Address
First Line : 3057 29TH ST
Second Line : #2C
City : ASTORIA
State : NY
Zip : 11102-2549
Country : US
Telephone Number : 917-543-7013
Fax Number :
Provider Business Practice Location Address
First Line : 2510 30TH AVE
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11102-2448
Country : US
Telephone Number : 718-267-4285
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2006
Last Update Date : 11/01/2010

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Directions to “ JENNIFER STOREY PA” Practice Location

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