Provider Demographics
NPI:1235468737
Name:FEGAN-SZALAY, JENNIFER M (LM CM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:FEGAN-SZALAY
Suffix:
Gender:F
Credentials:LM CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1676 COLUMBIA TPKE
Mailing Address - Street 2:
Mailing Address - City:CASTLETON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9533
Mailing Address - Country:US
Mailing Address - Phone:518-732-5150
Mailing Address - Fax:518-478-8827
Practice Address - Street 1:1676 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:CASTLETON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12033-9533
Practice Address - Country:US
Practice Address - Phone:518-732-5150
Practice Address - Fax:518-478-8827
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001432176B00000X
NY28-P78236176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04687303Medicaid