MEDICARE: PRAISY JOHN MS, FNP-BC, BS, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F340919-1	NY

General Provider Information

NPI Number	:	1164976221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRAISY JOHN MS, FNP-BC, BS, RN

Provider Business Mailing Address
First Line	:	4545 CENTER BLVD
Second Line	:	APT 3219
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5901
Country	:	US
Telephone Number	:	240-920-9595
Fax Number	:

Provider Business Practice Location Address
First Line	:	4545 CENTER BLVD
Second Line	:	APT 3219
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5901
Country	:	US
Telephone Number	:	240-920-9595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2016
Last Update Date	:	08/06/2016

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