Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F304898-1 | NY |
NPI | 1003060229 |
---|---|
Provider Name | Ms. Janice Fleischman Eaton |
First Address | Port Jefferson, NY 11777-1957 |
Second Address | Port Jefferson, NY 11777-1957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2008 |
Last Update Date | 01/10/2010 |