Individual
DR. JESSICA DODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
420 E 80TH ST APT PHC, NEW YORK, NY 10075-1052
(203) 984-9847
Mailing address
420 E 80TH ST APT PHC, NEW YORK, NY 10075-1052
(203) 984-9847
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
305008
NY
2084P0804X
Child & Adolescent Psychiatry Physician
305008
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2017
Last updated
06/14/2022
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