Healthcare Provider Details

I. General information

NPI: 1740433697
Provider Name (Legal Business Name): JP MEDICAL OF NY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 E 13TH ST UNIT 1A
BROOKLYN NY
11229-2886
US

IV. Provider business mailing address

1829 E 13TH ST UNIT 1A
BROOKLYN NY
11229-2886
US

V. Phone/Fax

Practice location:
  • Phone: 551-486-0281
  • Fax: 201-567-3208
Mailing address:
  • Phone: 551-486-0281
  • Fax: 201-567-3208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number2157451
License Number StateNY

VIII. Authorized Official

Name: LINDA PISKUN
Title or Position: MANAGER
Credential:
Phone: 551-486-0281