Most Relevant Information
Provider Data
NPI Number: | 1003552522 |
Provider Name: | JACQUELINE MEDINA |
Entity Type: | Individual |
Taxonomy Code: | 101YM0800X |
Specialty: | Counselor |
License Number: |
Most Important Dates
Enumeration Date: | 05/08/2022 |
Last Updated: | 05/08/2022 |
Provider Practice Location
160 W 86TH ST
NEW YORK
NY
100244018
Practice Location Phone/Fax
Phone: | 2128751300 |
Fax: |
Provider Mailing Location
5272 72ND ST FL 1
MASPETH
NY
113781436
Provider Mailing Phone/Fax
Phone: | 3472955181 |
Fax: |