Provider Demographics
NPI:1932575578
Name:CARNERALE, JACLYN LEE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:LEE
Last Name:CARNERALE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JACLY
Other - Middle Name:LEE
Other - Last Name:MANNION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:600 NORTHERN BLVD.
Mailing Address - Street 2:SUITE #111
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-387-3990
Mailing Address - Fax:
Practice Address - Street 1:111 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7410
Practice Address - Country:US
Practice Address - Phone:516-680-7538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018929363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical