Provider Demographics
NPI:1699284091
Name:LYNCH, JENNIFER MARIE (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:700 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1536
Mailing Address - Country:US
Mailing Address - Phone:716-854-5700
Mailing Address - Fax:716-854-5800
Practice Address - Street 1:700 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1536
Practice Address - Country:US
Practice Address - Phone:716-854-5700
Practice Address - Fax:716-854-5800
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021399363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant