Healthcare Provider Details

I. General information

NPI: 1992719470
Provider Name (Legal Business Name): JEAN M BELLINGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 KING ST
OGDENSBURG NY
13669-1142
US

IV. Provider business mailing address

103 RENSSELAER ST
HEUVELTON NY
13654
US

V. Phone/Fax

Practice location:
  • Phone: 315-393-3600
  • Fax:
Mailing address:
  • Phone: 315-324-5941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number290F333773
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: