Healthcare Provider Details

I. General information

NPI: 1598445991
Provider Name (Legal Business Name): SETH MEJIAS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 4TH AVE
BROOKLYN NY
11220-1117
US

IV. Provider business mailing address

2441 31ST ST # 1125
ASTORIA NY
11102-1140
US

V. Phone/Fax

Practice location:
  • Phone: 718-680-8881
  • Fax: 718-680-7880
Mailing address:
  • Phone: 315-783-7411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF352526-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: