Provider Demographics
NPI:1437411899
Name:POTTER, JANINE MARIE
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:MARIE
Last Name:POTTER
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 1:300 S CENTRAL AVE
Mailing Address - Street 2:APARTMENT B37
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3146
Mailing Address - Country:US
Mailing Address - Phone:914-776-8300
Mailing Address - Fax:
Practice Address - Street 1:300 S CENTRAL AVE
Practice Address - Street 2:APARTMENT B37
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3146
Practice Address - Country:US
Practice Address - Phone:914-776-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist