Provider Demographics
NPI:1558058206
Name:JINSON, ANGEL MARIAM (NP)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:MARIAM
Last Name:JINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:MARIAM
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 CLEARMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1211
Mailing Address - Country:US
Mailing Address - Phone:347-515-9296
Mailing Address - Fax:
Practice Address - Street 1:510 HEMPSTEAD TPKE RM 203
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1152
Practice Address - Country:US
Practice Address - Phone:516-505-7200
Practice Address - Fax:949-419-3482
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404302363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health