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General NPI Number Information
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NPI Number | 1477159515
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Entity Type | Individual
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Provider Name | GAETAN JEAN MARIE DNP-FNP
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Gender | Male
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 22764 114TH AVE
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City | CAMBRIA HEIGHTS
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State | NY
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Zip | 11411-1304
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Country | US
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Telephone | 516-637-9764
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Fax |
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Provider Business Mailing Address
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Address Line | 3415 PARSONS BLVD
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City | FLUSHING
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State | NY
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Zip | 11354-4623
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Country | US
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Telephone | 516-637-9764
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 346718-01
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License Number State | NY
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