Provider Demographics
NPI:1184857336
Name:TYCHNOWITZ, JANELLE LYNN (RN, CPN, PNP)
Entity Type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:LYNN
Last Name:TYCHNOWITZ
Suffix:
Gender:F
Credentials:RN, CPN, PNP
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Mailing Address - Street 1:3241 ROUTE 112
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1434
Mailing Address - Country:US
Mailing Address - Phone:631-732-5222
Mailing Address - Fax:631-732-6222
Practice Address - Street 1:3241 ROUTE 112
Practice Address - Street 2:SUITE 7
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-1434
Practice Address - Country:US
Practice Address - Phone:631-732-5222
Practice Address - Fax:631-732-6222
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY544842-1163WP0200X
NYF382571-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics