Provider Demographics
NPI:1467110924
Name:NEWMAN, JARED (AGNP-C)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11020 71ST RD APT 819
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4904
Mailing Address - Country:US
Mailing Address - Phone:631-235-2772
Mailing Address - Fax:
Practice Address - Street 1:11020 71ST RD APT 819
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4904
Practice Address - Country:US
Practice Address - Phone:631-235-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310533363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health