Individual
JACKELINE M NEAL MENZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
391 E 149TH ST RM 417, BRONX, NY 10455-3907
(646) 702-6965
Mailing address
391 E 149TH ST RM 417, BRONX, NY 10455-3907
(646) 702-6965
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
328546204
—
NY
Enumeration date
12/03/2018
Last updated
12/03/2018
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