Individual
JILL FENNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
818 ELLICOTT ST, BUFFALO, NY 14203-1021
(716) 323-0034
(716) 323-0292
Mailing address
1001 MAIN ST FL 5, BUFFALO, NY 14203-1009
(716) 323-0034
(716) 323-0292
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
290206
NY
208M00000X
Hospitalist Physician
Primary
290206
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05953255
—
NY
Enumeration date
05/01/2014
Last updated
01/13/2021
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