Healthcare Provider Details

I. General information

NPI: 1669859096
Provider Name (Legal Business Name): JASON MEISEL PMHNP-BC, RN-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CADMAN PLZ W FL 12
BROOKLYN NY
11201-3226
US

IV. Provider business mailing address

300 CADMAN PLZ W FL 12
BROOKLYN NY
11201-3226
US

V. Phone/Fax

Practice location:
  • Phone: 740-777-6184
  • Fax: 206-309-3725
Mailing address:
  • Phone: 740-777-6184
  • Fax: 206-309-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401965
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number612103
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: