Provider Demographics
NPI:1174868723
Name:FENSTER, JAMIE ALLYSON (PA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ALLYSON
Last Name:FENSTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:SOKOLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:624 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1035
Mailing Address - Country:US
Mailing Address - Phone:516-382-6402
Mailing Address - Fax:
Practice Address - Street 1:624 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1035
Practice Address - Country:US
Practice Address - Phone:516-382-6402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-09
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016142-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant