Provider Demographics
NPI:1275413676
Name:BAKES, JENNY
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:BAKES
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 1:233 34TH ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-2318
Mailing Address - Country:US
Mailing Address - Phone:646-784-6672
Mailing Address - Fax:
Practice Address - Street 1:233 34TH ST APT 1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-2318
Practice Address - Country:US
Practice Address - Phone:646-784-6672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program