MEDICARE: SOPHONIE JEAN-PHILIPPE LPN

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
1	363LF0000X	Family Nurse Practitioner	359189	NY
2	163W00000X	Registered Nurse	761444	NY

General Provider Information

NPI Number	:	1912453283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHONIE JEAN-PHILIPPE LPN

Provider Business Mailing Address
First Line	:	5210 BROADWAY APT 5H
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-7617
Country	:	US
Telephone Number	:	718-313-7676
Fax Number	:

Provider Business Practice Location Address
First Line	:	5210 BROADWAY
Second Line	:	5H
City	:	BRONX
State	:	NY
Zip	:	10463
Country	:	US
Telephone Number	:	728-313-7676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2016
Last Update Date	:	03/15/2026

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