Provider Demographics
NPI:1093314320
Name:JEAN-NOEL, MCNAMARY H
Entity Type:Individual
Prefix:
First Name:MCNAMARY
Middle Name:H
Last Name:JEAN-NOEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 PATRICIA LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1246
Mailing Address - Country:US
Mailing Address - Phone:347-388-1748
Mailing Address - Fax:
Practice Address - Street 1:47 PATRICIA LN
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1246
Practice Address - Country:US
Practice Address - Phone:347-388-1748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000653-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty