Provider Demographics
NPI:1114116530
Name:PROSPER, JEANNE
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:
Last Name:PROSPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WEST 69TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4740
Mailing Address - Country:US
Mailing Address - Phone:212-579-0914
Mailing Address - Fax:
Practice Address - Street 1:27 WEST 69TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4740
Practice Address - Country:US
Practice Address - Phone:212-579-0914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00342443Medicaid
NY00342443Medicaid