Jenna Nicole Coluccio
Physician Assistant in New York, NY. Individual provider (NPI-1).
NPI number1982178554
StatusActive
Last updated in NPPESJan 17, 2019
Details
- NPI
- 1982178554
- Entity type
- Individual (NPI-1)
- Name
- Jenna Nicole Coluccio
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 17, 2019
- Last updated
- Jan 17, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | – | – | Yes |
Practice location
170 William StNew York, NY 10038-2612
Phone 212-312-5000
Mailing address
3125 Enos StBellmore, NY 11710-5318
Phone 516-512-0044
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