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General NPI Number Information
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NPI Number | 1245046903
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Entity Type | Individual
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Provider Name | JUSTIN PEDERSON RN, AGACNP
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Gender | Male
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Dates
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Enumeration Date | 12/07/2024
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Last Update Date | 12/07/2024
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Provider Practice Location Address
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Address Line | 424 E 34TH ST FL 16
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City | NEW YORK
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State | NY
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Zip | 10016-4901
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Country | US
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Telephone | 646-929-7870
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Fax |
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Provider Business Mailing Address
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Address Line | 28 BOX ST APT N233
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City | BROOKLYN
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State | NY
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Zip | 11222-5586
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Country | US
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Telephone | 425-458-8947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 433062
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License Number State | NY
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