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NPI Code Detail

MEDICARE: MR. JEAN LUTHER PAINSON NP

MEDICARE:  MR. JEAN LUTHER PAINSON  NP
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerF401460NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2401460OTHERNURSE PRACTITIONER LICENSE

General Provider Information

NPI Number : 1881969251
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEAN LUTHER PAINSON NP
Provider Business Mailing Address
First Line : 1016 E 81ST ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-4222
Country : US
Telephone Number : 718-812-0236
Fax Number :
Provider Business Practice Location Address
First Line : 1016 E 81ST ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-4222
Country : US
Telephone Number : 717-716-7107
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2012
Last Update Date : 05/17/2024

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