Basic Information
| Provider Information | |||||||||
| NPI: | 1659628865 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEEKENS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | GROGAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | F.N.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2570 ROUTE 9W STE 10 | ||||||||
| Address2: | |||||||||
| City: | CORNWALL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125181370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452203100 | ||||||||
| FaxNumber: | 8455342940 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 OLD FIREHOUSE ROAD | ||||||||
| Address2: | |||||||||
| City: | WALLKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453936015 | ||||||||
| FaxNumber: | 8453936016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2012 | ||||||||
| LastUpdateDate: | 07/26/2018 | ||||||||
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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 | 363LF0000X | 5007361 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 337181 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.