Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 309431 | NY |
NPI | 1003312604 |
---|---|
Provider Name | Dr. James Nicholas Jennings |
First Address | Cooperstown, NY 13326-1301 |
Second Address | Oneonta, NY 13820-2099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2018 |
Last Update Date | 13/08/2021 |