Healthcare Provider Details

I. General information

NPI: 1487133294
Provider Name (Legal Business Name): JJGNP IN ADULT HEALTH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 SHORE RD
MOUNT SINAI NY
11766-1419
US

IV. Provider business mailing address

77 SHORE RD
MOUNT SINAI NY
11766-1419
US

V. Phone/Fax

Practice location:
  • Phone: 631-642-2200
  • Fax: 631-642-2195
Mailing address:
  • Phone: 631-642-2200
  • Fax: 631-642-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM BEZMEN
Title or Position: AUTHORIZED OFFICIAL
Credential: PH. D, PMH, C.N.S.
Phone: 516-659-5109