Provider Demographics
NPI:1194108977
Name:FAVRE, JENNIFER LYNN (MD MPH)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:FAVRE
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:OLINSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:200 PANTIGO PL STE E
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-5925
Mailing Address - Country:US
Mailing Address - Phone:316-324-8030
Mailing Address - Fax:631-324-8032
Practice Address - Street 1:200 PANTIGO PL STE E
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937
Practice Address - Country:US
Practice Address - Phone:718-780-5260
Practice Address - Fax:718-780-3266
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294839208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics