1902024672 NPI number — MS. LYNNE MICHELLE JENNINGS RPA

Table of content: MS. LYNNE MICHELLE JENNINGS RPA (NPI 1902024672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902024672 NPI number — MS. LYNNE MICHELLE JENNINGS RPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENNINGS
Provider First Name:
LYNNE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JENNINGS
Provider Other First Name:
LYNNE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902024672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 SHIRLEY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BABYLON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11704-6809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-383-5226
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
97 AMITY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201-6004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-780-1647
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  003146-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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