Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F338709 | NY |
NPI | 1003288762 |
---|---|
Provider Name | Alfred Jean |
First Address | New York, NY 10039 |
Second Address | Bronx, NY 10460-4363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2015 |
Last Update Date | 29/03/2017 |