Provider Demographics
NPI:1164254553
Name:GAME, JENNIFER
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:GAME
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 1:26 W 13TH RD
Mailing Address - Street 2:
Mailing Address - City:BROAD CHANNEL
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1102
Mailing Address - Country:US
Mailing Address - Phone:917-547-8799
Mailing Address - Fax:
Practice Address - Street 1:26 W 13TH RD
Practice Address - Street 2:
Practice Address - City:BROAD CHANNEL
Practice Address - State:NY
Practice Address - Zip Code:11693-1102
Practice Address - Country:US
Practice Address - Phone:917-547-8799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022965225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist