Provider Demographics
NPI:1588926067
Name:JOLY, JENNIFER A (MSED)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:JOLY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 DUNHILL DR
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-6540
Mailing Address - Country:US
Mailing Address - Phone:845-278-0180
Mailing Address - Fax:
Practice Address - Street 1:2002 DUNHILL DR
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-6540
Practice Address - Country:US
Practice Address - Phone:845-278-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1824822171W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171W00000XOther Service ProvidersContractor