Provider Demographics
NPI:1477159515
Name:JEAN MARIE, GAETAN (DNP-FNP)
Entity Type:Individual
Prefix:MR
First Name:GAETAN
Middle Name:
Last Name:JEAN MARIE
Suffix:
Gender:M
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 PARSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4623
Mailing Address - Country:US
Mailing Address - Phone:516-637-9764
Mailing Address - Fax:
Practice Address - Street 1:22764 114TH AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1304
Practice Address - Country:US
Practice Address - Phone:516-637-9764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346718-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty