Provider Demographics
NPI:1174747091
Name:RAY-TERRY, JENNIFER (RPA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RAY-TERRY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4364
Mailing Address - Country:US
Mailing Address - Phone:516-750-2500
Mailing Address - Fax:516-483-3592
Practice Address - Street 1:540 FULTON AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4364
Practice Address - Country:US
Practice Address - Phone:516-750-2500
Practice Address - Fax:516-483-3592
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004039-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant