Individual
JENNIFER ROSE DEFAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5841 S MARYLAND AVE, CHICAGO, IL 60637-1447
(773) 702-1000
Mailing address
3959 BROADWAY RM 216B, NEW YORK, NY 10032-1559
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
288868-1
NY
Other
Enumeration date
07/05/2010
Last updated
01/23/2020
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