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Individual

MS. LISA MICHELLE JENKINS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
160 W 100TH ST, NEW YORK, NY 10025-5145
(464) 841-2956
(646) 364-0780
Mailing address
160 W 100TH ST RM 226, NEW YORK, NY 10025-5145
(646) 484-1295
(646) 364-0780

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
217561
NY
208000000X
Pediatrics Physician
MA068681
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0022217
NJ
Enumeration date
06/23/2006
Last updated
03/19/2021
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