Most Relevant Information
Provider Data
| NPI Number: | 1003645144 |
| Provider Name: | JASON KETTENRING |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/29/2024 |
| Last Updated: | 07/29/2024 |
Provider Practice Location
177 FT WASHINGTN AVE
NEW YORK
NY
100323733
Practice Location Phone/Fax
| Phone: | 2123052500 |
| Fax: |
Provider Mailing Location
14517 17TH RD
WHITESTONE
NY
113573026
Provider Mailing Phone/Fax
| Phone: | 3477562728 |
| Fax: |