Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F338701 | NY |
NPI | 1003278623 |
---|---|
Provider Name | Cynthia Jean |
First Address | Bronx, NY 10461-2507 |
Second Address | Bronx, NY 10453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2016 |
Last Update Date | 27/04/2021 |