Jaclyn Paige Stukat Gren, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA053902 Issued in PA

Practice address

60 Wall St
34 Floor
New York, NY 10005-2836

Phone

(212) 250-7753

Fax

(212) 797-0808

NPI assigned

Jul 1, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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": "1372636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450051200000",
    "number": "1396185609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 WALL ST",
            "address_2": "34 FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100052836",
            "telephone_number": "212-250-7753",
            "fax_number": "212-797-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 WALL ST",
            "address_2": "34 FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100052836",
            "telephone_number": "212-250-7753",
            "fax_number": "212-797-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUKAT GREN",
        "first_name": "JACLYN",
        "middle_name": "PAIGE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-01",
        "last_updated": "2015-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA053902",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018631-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J Patrick Stuebgen, MD
• Kami Stufflebeam
• Karen Meryl Stugensky, RPA-C
• Joseph Stujenske, MD, PHD
• Joel J Stukalin, PH.D.
• Jasmine Stukes
• Danica Stull
• James K Stulman, MD
• Christopher B Stults, PHD
• Erik Joseph Stump, DDS

• Physician Assistant in New York, NY
• Providers in New York, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2015; 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.