Healthcare Provider Details

I. General information

NPI: 1124695325
Provider Name (Legal Business Name): JOHN SEXTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 KINGS HWY
BROOKLYN NY
11234-2625
US

IV. Provider business mailing address

18451 27 MILE RD
RAY MI
48096-3554
US

V. Phone/Fax

Practice location:
  • Phone: 718-252-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF347408-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: