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General NPI Number Information
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NPI Number | 1487133294
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Entity Type | Organization
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Legal Business Name | JJGNP IN ADULT HEALTH, P.C.
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 77 SHORE RD
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City | MOUNT SINAI
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State | NY
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Zip | 11766-1419
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Country | US
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Telephone | 631-642-2200
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Fax | 631-642-2195
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Provider Business Mailing Address
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Address Line | 77 SHORE RD
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City | MOUNT SINAI
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State | NY
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Zip | 11766-1419
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Country | US
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Telephone | 631-642-2200
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Fax | 631-642-2195
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | WILLIAM BEZMEN
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Credential | PH. D, PMH, C.N.S.
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Telephone | 516-659-5109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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