Provider Demographics
NPI:1568741437
Name:EFFREN, JESSICA LAUREN (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:EFFREN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LAUREN
Other - Last Name:MERLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:600 NORTHERN BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5206
Mailing Address - Country:US
Mailing Address - Phone:516-627-8717
Mailing Address - Fax:516-570-4037
Practice Address - Street 1:600 NORTHERN BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5206
Practice Address - Country:US
Practice Address - Phone:516-627-8717
Practice Address - Fax:516-570-4037
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014883363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant