Basic Information
| Provider Information | |||||||||
| NPI: | 1396973889 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABRERA | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 E 115TH ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100291186 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7559 263RD ST | ||||||||
| Address2: | |||||||||
| City: | GLEN OAKS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110041150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184708005 | ||||||||
| FaxNumber: | 7189627717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2009 | ||||||||
| LastUpdateDate: | 04/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | 259879 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.