Healthcare Provider Details

I. General information

NPI: 1003288762
Provider Name (Legal Business Name): ALFRED JEAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 E TREMONT AVE
BRONX NY
10460-4363
US

IV. Provider business mailing address

2816 8TH AVENUE
NEW YORK NY
10039
US

V. Phone/Fax

Practice location:
  • Phone: 718-860-1111
  • Fax: 646-240-1320
Mailing address:
  • Phone: 410-800-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF338709
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: