Provider Demographics
NPI:1174357636
Name:OCONNOR, JENNIFER ELAINE
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:ELAINE
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 W DENIS LN
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3563
Mailing Address - Country:US
Mailing Address - Phone:631-740-0743
Mailing Address - Fax:
Practice Address - Street 1:3500 SUNRISE HWY STE 111
Practice Address - Street 2:
Practice Address - City:GREAT RIVER
Practice Address - State:NY
Practice Address - Zip Code:11739-1001
Practice Address - Country:US
Practice Address - Phone:631-650-6545
Practice Address - Fax:631-650-6546
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program