Provider Demographics
NPI:1265420400
Name:JENKS, JAMES EMERSON (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EMERSON
Last Name:JENKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 MCKENZIE POND RD
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-2560
Mailing Address - Country:US
Mailing Address - Phone:518-275-9151
Mailing Address - Fax:
Practice Address - Street 1:729 MCKENZIE POND RD
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-2560
Practice Address - Country:US
Practice Address - Phone:518-275-9251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138704207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00907608Medicaid
B81198Medicare UPIN
RA0921Medicare ID - Type Unspecified