Provider Demographics
NPI:1831514132
Name:JANOCHA, JENNIFER M (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:JANOCHA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 INSTITUTE ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6628
Mailing Address - Country:US
Mailing Address - Phone:716-484-4334
Mailing Address - Fax:716-484-4140
Practice Address - Street 1:107 INSTITUTE ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6628
Practice Address - Country:US
Practice Address - Phone:716-484-4334
Practice Address - Fax:716-484-4140
Is Sole Proprietor?:No
Enumeration Date:2014-02-23
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NC0010-04909363A00000X
NY18953363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1831514132Medicaid
SC1929PAMedicaid
NY4293716Medicaid
NCNCJ901AMedicare PIN