Provider Demographics
NPI:1093553653
Name:KRUPA, JENNA MARY (PA-C)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARY
Last Name:KRUPA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 FIELDSTONE DR APT 171
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1552
Mailing Address - Country:US
Mailing Address - Phone:347-852-1753
Mailing Address - Fax:
Practice Address - Street 1:122 WILMOT RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1007
Practice Address - Country:US
Practice Address - Phone:203-503-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6669363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant