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General NPI Number Information
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NPI Number | 1861091324
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Entity Type | Individual
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Provider Name | STACEY M JANTSCH AGNP
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Gender | Female
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Dates
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Enumeration Date | 10/25/2020
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 169 MADISON AVE STE 2817
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City | NEW YORK
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State | NY
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Zip | 10016-5101
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Country | US
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Telephone | 888-553-2823
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Fax | 888-553-2823
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Provider Business Mailing Address
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Address Line | 169 MADISON AVE STE 2817
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City | NEW YORK
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State | NY
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Zip | 10016-5101
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Country | US
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Telephone | 888-553-2823
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Fax | 888-553-2823
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704415079
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License Number State | MI
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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 | F310040-01
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 310040
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 310040
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 310040
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License Number State | NY
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