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NPI Code Detail

MEDICARE: JENNIFER ANNE DEGROFF

MEDICARE: JENNIFER ANNE DEGROFF
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
1174400000XSpecialist

General Provider Information

NPI Number : 1649932591
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ANNE DEGROFF
Provider Business Mailing Address
First Line : 329 N KENTUCKY AVE
Second Line :
City : N MASSAPEQUA
State : NY
Zip : 11758-1120
Country : US
Telephone Number : 516-993-4204
Fax Number :
Provider Business Practice Location Address
First Line : 99 CENTRAL AVE
Second Line :
City : AMITYVILLE
State : NY
Zip : 11701-3537
Country : US
Telephone Number : 516-317-9284
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2021
Last Update Date : 10/07/2021

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Directions to “ JENNIFER ANNE DEGROFF ” Practice Location

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