Provider Demographics
NPI:1023519899
Name:BOMWELL, JENNIFER ANN (MA LAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:BOMWELL
Suffix:
Gender:F
Credentials:MA LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PROSPECT PL
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-5004
Mailing Address - Country:US
Mailing Address - Phone:646-938-3302
Mailing Address - Fax:
Practice Address - Street 1:100 S HIGHLAND AVE STE A
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-5634
Practice Address - Country:US
Practice Address - Phone:646-938-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05796171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist