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NPI Code Detail

MEDICARE: MR. JUAN GAETAN CPNP-PC

MEDICARE: MR. JUAN GAETAN CPNP-PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse466314NY
2363LP0200XPediatric Nurse PractitionerF381315NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730165192
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JUAN GAETAN CPNP-PC
Provider Business Mailing Address
First Line : 2094 PITKIN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11207-3509
Country : US
Telephone Number : 718-240-0400
Fax Number :
Provider Business Practice Location Address
First Line : 82-68 164TH ST.
Second Line : DEPARTMENT OF EMERGENCY MEDICINE
City : JAMAICA
State : NY
Zip : 11432-1121
Country : US
Telephone Number : 718-883-3075
Fax Number : 718-883-6115
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2005
Last Update Date : 05/30/2024

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