Jennifer Bannen
Specialist in Middle Island, NY. Individual provider (NPI-1).
NPI number1225916331
StatusActive
Last updated in NPPESAug 26, 2025
Details
- NPI
- 1225916331
- Entity type
- Individual (NPI-1)
- Name
- Jennifer Bannen
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 26, 2025
- Certification date
- Aug 26, 2025
- Last updated
- Aug 26, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | – | – | Yes |
Practice location
Po Box 12Middle Island, NY 11953-0012
Phone 631-924-0008
Mailing address
138 Adams St EEast Islip, NY 11730-1623
Phone 631-224-1151
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