Healthcare Provider Details

I. General information

NPI: 1073630299
Provider Name (Legal Business Name): JEANETTE BETH BEYER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7559 263RD ST
GLEN OAKS NY
11004-1150
US

IV. Provider business mailing address

7559 263RD ST
GLEN OAKS NY
11004-1150
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-8538
  • Fax: 718-347-5514
Mailing address:
  • Phone: 718-470-8538
  • Fax: 718-347-5514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF400537
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number391088
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: