Provider Demographics
NPI:1962699355
Name:JUSINO, JENNIFER (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:JUSINO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:OSORIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5645 MAIN STREET
Mailing Address - Street 2:DEPARTMENT OF OB/GYN
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-670-1517
Mailing Address - Fax:
Practice Address - Street 1:5645 MAIN STREET
Practice Address - Street 2:DEPARTMENT OF OB/GYN
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-670-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012072363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant