Healthcare Provider Details

I. General information

NPI: 1538245741
Provider Name (Legal Business Name): JANINE NATHAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 FRANKLIN PL
WOODMERE NY
11598
US

IV. Provider business mailing address

115 FRANKLIN PL
WOODMERE NY
11598
US

V. Phone/Fax

Practice location:
  • Phone: 516-295-1200
  • Fax: 516-295-1207
Mailing address:
  • Phone: 516-569-1200
  • Fax: 516-295-1207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number225365
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: