MEDICARE: HARRY SMITH JEANTY

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	207R00000X	Internal Medicine Physician	60-P129312-01	NY

General Provider Information

NPI Number	:	1609611516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRY SMITH JEANTY

Provider Business Mailing Address
First Line	:	600 E CRESCENT AVE
Second Line	:
City	:	UPPER SADDLE RIVER
State	:	NJ
Zip	:	07458-1846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3518 BAINBRIDGE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-1402
Country	:	US
Telephone Number	:	718-655-1991
Fax Number	:

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

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	07/01/2024

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