Healthcare Provider Details

I. General information

NPI: 1093652448
Provider Name (Legal Business Name): PIERCE JANSSEN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BROADWAY RM 1706
NEW YORK NY
10006-1918
US

IV. Provider business mailing address

174 WASHINGTON ST APT 2F
JERSEY CITY NJ
07302-6500
US

V. Phone/Fax

Practice location:
  • Phone: 212-803-9070
  • Fax: 212-803-9077
Mailing address:
  • Phone: 516-458-2618
  • Fax: 212-803-9077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PIERCE LAWRENCE JANSSEN
Title or Position: OWNER
Credential: MD
Phone: 516-458-2618