MEDICARE: JUANITA JENYONS M.D.

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	207V00000X	Obstetrics & Gynecology Physician	141676-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457352833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANITA JENYONS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 32577
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06150-2577
Country	:	US
Telephone Number	:	201-804-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 W 77TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-5128
Country	:	US
Telephone Number	:	212-769-4171
Fax Number	:

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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