Provider Demographics
NPI:1285021766
Name:EAPEN, JENSON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JENSON
Middle Name:
Last Name:EAPEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DAKOTA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1119
Mailing Address - Country:US
Mailing Address - Phone:516-622-2900
Mailing Address - Fax:516-622-2901
Practice Address - Street 1:1 DAKOTA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1119
Practice Address - Country:US
Practice Address - Phone:516-622-2900
Practice Address - Fax:516-622-2901
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018594363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant