Jacklyn Perillo McKenna

Primary specialty

SpecialistTaxonomy code 174400000X

License

1464094211 Issued in NY

Practice address

1400 Old Country Rd Ste C103N
Westbury, NY 11590-5156

Phone

(516) 806-6363

NPI assigned

Sep 6, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1124853379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9601 161ST AVE",
            "city": "HOWARD BEACH",
            "state": "NY",
            "postal_code": "114143828",
            "telephone_number": "516-660-6307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 OLD COUNTRY RD STE C103N",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "115905156",
            "telephone_number": "516-806-6363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENNA",
        "first_name": "JACKLYN",
        "middle_name": "PERILLO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-06",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "1464094211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara McGuckin
• McHade Pharmaceuticals Inc.
• Jeanne McKeefrey
• Jay Alexander McKeehan, PA-C, NREMT-P
• Claire Bridget McKenna
• Yazmin Iesha McNair
• Caitlyn McNeill
• Tricia Ann McNeilly
• Janis Meadow
• Meadowbrook Medical Associates

• Specialist in Westbury, NY
• Providers in Westbury, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.