Provider Demographics
NPI:1194982280
Name:KNISHINSKY, JENNIFER NIERMAN (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NIERMAN
Last Name:KNISHINSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELYSE
Other - Last Name:NIERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 W 26TH ST
Mailing Address - Street 2:APARTMENT 14L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1001
Mailing Address - Country:US
Mailing Address - Phone:215-370-6349
Mailing Address - Fax:
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:PRIMARY CARE CLINIC, ROOM 2130
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-18
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine