Healthcare Provider Details

I. General information

NPI: 1073395968
Provider Name (Legal Business Name): FRANTZ DORESTANT JR. CWOCN AGPCNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 66TH RD
FOREST HILLS NY
11375-2029
US

IV. Provider business mailing address

3382 OCEAN HARBOR DR
OCEANSIDE NY
11572-3534
US

V. Phone/Fax

Practice location:
  • Phone: 646-240-9067
  • Fax:
Mailing address:
  • Phone: 646-240-9067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number19995
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG10230069
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License Number19995
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License Number19995
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number19995
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: