Provider Demographics
NPI:1558168716
Name:GERVASI, JENI
Entity type:Individual
Prefix:
First Name:JENI
Middle Name:
Last Name:GERVASI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 TOOKER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-5048
Mailing Address - Country:US
Mailing Address - Phone:631-513-3290
Mailing Address - Fax:
Practice Address - Street 1:1060 TOOKER AVE
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-5048
Practice Address - Country:US
Practice Address - Phone:631-513-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty