Provider Demographics
NPI:1902373699
Name:CROWE, JENNIFER IVY
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:IVY
Last Name:CROWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4893 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4698
Mailing Address - Country:US
Mailing Address - Phone:716-608-7040
Mailing Address - Fax:
Practice Address - Street 1:5844 SOUTHWESTERN BLVD STE 500
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-3685
Practice Address - Country:US
Practice Address - Phone:716-646-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025382363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant