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Individual

JENNIFER MARIE GODLEWSKI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
5496 E TAFT RD, NORTH SYRACUSE, NY 13212-3773
(315) 552-6700
Mailing address
PO BOX 510, SYRACUSE, NY 13214-0510
(315) 552-6700

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
015166-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03439278
NY
Enumeration date
09/13/2006
Last updated
01/15/2021
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