Individual
JENNIFER SULKOW
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6 EXECUTIVE PARK DR, ALBANY, NY 12203-3791
(518) 482-9111
(518) 482-6142
Mailing address
6 EXECUTIVE PARK DR, ALBANY, NY 12203-3791
(518) 482-9111
(518) 482-6142
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4879021
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000499324001
BLUE SHIELD OF NORTHEASTE
NY
01
—
4123605
MOHAWK VALLEY PHYSICIANS
NY
Enumeration date
02/23/2006
Last updated
07/08/2007
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