Healthcare Provider Details

I. General information

NPI: 1922254358
Provider Name (Legal Business Name): PATRICIA R JANSON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANETTO HILL RD SUITE 205
PLAINVIEW NY
11803
US

IV. Provider business mailing address

100 MANETTO HILL RD SUITE 205
PLAINVIEW NY
11803
US

V. Phone/Fax

Practice location:
  • Phone: 917-224-2214
  • Fax: 646-219-4358
Mailing address:
  • Phone: 917-224-2214
  • Fax: 646-219-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400305
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberF400305
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number383131-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: