WALLACE RUSSELL JENKINS MD NPI 1487654653

NPI Information

  • NPI: 1487654653
  • Provider Name: WALLACE RUSSELL JENKINS, MD
  • Classification: Pediatrics - 2080A0000X
  • Specialization: Adolescent Medicine
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 503 GRASSLANDS RD
    STE 200
    VALHALLA, NY
    ZIP 10595
  • Phone: (914) 304-5288

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NPI Details

Wallace Russell Jenkins, MD is an adolescent medicine pediatrics in Valhalla, NY. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. Wallace Russell Jenkins, MD NPI is 1487654653. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

503 GRASSLANDS RD
STE 200
VALHALLA, NY
ZIP 10595
Phone: (914) 304-5288
Fax: (914) 345-1755

The NPI 1487654653 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/28/2005 and was last updated on 7/23/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12080A0000XPediatricsAdolescent Medicine183800NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1E95140MEDICARE UPINNEW YORK
201210104MEDICAIDNEW YORK
394F871MEDICARE PINNEW YORK
494F87EA202MEDICARE PINNEW YORK
594F87EA201MEDICARE PINNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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