MEDICARE: JENNIFER ROSEMARIE ANDERSON

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
1	174400000X	Specialist	451469101	NY

General Provider Information

NPI Number	:	1295159036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ROSEMARIE ANDERSON

Provider Business Mailing Address
First Line	:	1565 RICHMOND RD APT 2F
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2329
Country	:	US
Telephone Number	:	646-525-6708
Fax Number	:

Provider Business Practice Location Address
First Line	:	1565 RICHMOND RD APT 2F
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2329
Country	:	US
Telephone Number	:	646-525-6708
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2014
Last Update Date	:	02/14/2014

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Directions to “ JENNIFER ROSEMARIE ANDERSON ” Practice Location

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