Healthcare Provider Details

I. General information

NPI: 1013568153
Provider Name (Legal Business Name): JAIME LUIS BETANCOURT DNP, MPH, APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 W 25TH ST FL 11
NEW YORK NY
10001-7405
US

IV. Provider business mailing address

500 PATERSON PLANK RD # 31043
UNION CITY NJ
07087-3416
US

V. Phone/Fax

Practice location:
  • Phone: 646-926-5758
  • Fax: 646-775-4142
Mailing address:
  • Phone: 732-491-1875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01039400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344643
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407386
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: