Basic Information
| Provider Information | |||||||||
| NPI: | 1912902701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VINCENT | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 WESTCHESTER AVE | ||||||||
| Address2: | STE 307 | ||||||||
| City: | PURCHASE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105772551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142497000 | ||||||||
| FaxNumber: | 9142497032 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 ASTOR AVE | ||||||||
| Address2: | LBBY 1E | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104695900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186520003 | ||||||||
| FaxNumber: | 7186520815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 007190 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.