Provider Demographics
NPI:1861635344
Name:JENNIFER R HILL MD PLLC
Entity type:Organization
Organization Name:JENNIFER R HILL MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FPMRS
Authorized Official - Phone:631-405-0898
Mailing Address - Street 1:9 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5409
Mailing Address - Country:US
Mailing Address - Phone:631-405-0898
Mailing Address - Fax:
Practice Address - Street 1:74 COMMERCE AVE STE 1
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3105
Practice Address - Country:US
Practice Address - Phone:631-405-0898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241574208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty