Basic Information
| Provider Information | |||||||||
| NPI: | 1194108977 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAVRE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD MPH | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OLINSKY | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD, MPH | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 200 PANTIGO PL STE E | ||||||||
| Address2: | |||||||||
| City: | EAST HAMPTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119375925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3163248030 | ||||||||
| FaxNumber: | 6313248032 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 PANTIGO PL STE E | ||||||||
| Address2: | |||||||||
| City: | EAST HAMPTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187805260 | ||||||||
| FaxNumber: | 7187803266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2015 | ||||||||
| LastUpdateDate: | 07/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 294839 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.