Provider Demographics
NPI:1285258806
Name:AUSTIN, JEAN J
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:J
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:J
Other - Last Name:MAGNOTTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 GREENRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-3110
Mailing Address - Country:US
Mailing Address - Phone:914-831-9331
Mailing Address - Fax:
Practice Address - Street 1:145 GREENRIDGE AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-3110
Practice Address - Country:US
Practice Address - Phone:914-831-9331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist