Jenny Johanna Wada, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

021927 Issued in NY

Practice address

5141 Broadway
New York, NY 10034-1159

Phone

(212) 932-4000

NPI assigned

Mar 21, 2018

Sex

Female

Sole proprietor

Yes

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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: jnw9052@direct.nyp.org

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

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521590400000",
    "number": "1760986939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 E 76TH ST APT 17",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100212430",
            "telephone_number": "347-400-7369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5141 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100341159",
            "telephone_number": "212-932-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADA",
        "first_name": "JENNY",
        "middle_name": "JOHANNA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-21",
        "last_updated": "2018-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "021927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessina Rose Wachtelhausen, RN
• Eileen Renee Wachter, MD
• Mary Patricia Karmel Wachter, PH.D.
• Debra Wachtler
• Melissa Wacks
• Janet Waddell
• Kelley P Waddell, RN
• Yaritza Waddell, PSYD
• Sara Wadden, LCSW-C
• Kylie Armentha Aquino Waddy, MSW

• 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 Mar 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.