Individual ProviderJennifer Lynn MabantaLicensed Practical NurseNursing Service ProvidersPractice Address210 Swezey St, East Patchogue, NY 11772-5702(631) 205-8584PECOS EnrollmentBased on the most recent information from CMS, provider Jennifer Lynn Mabanta does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1326546623Provider TypeIndividualFull NameMabanta, Jennifer LynnGenderFemaleSole ProprietorYesEnumeration Date2/1/2018Last Updated2/1/2018Contact InformationPractice LocationPractice Address210 Swezey St, East Patchogue, NY 11772-5702Phone(631) 205-8584FaxUnlisted FaxMailing LocationMailing Address210 Swezey St, East Patchogue, NY 11772-5702Phone(631) 205-8584Fax(631) 205-8584Provider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense298435New York