Provider Demographics
NPI:1144499773
Name:JENKINS, STEPHEN G (PHD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:JENKINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 29409, GPO
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-0001
Mailing Address - Country:US
Mailing Address - Phone:646-253-2808
Mailing Address - Fax:212-746-3856
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:BOX 69
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:646-253-2808
Practice Address - Fax:212-746-3856
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist