Provider Demographics
NPI:1619158912
Name:GUNOPAWIRO, JO ANNE (NPP)
Entity Type:Individual
Prefix:MS
First Name:JO ANNE
Middle Name:
Last Name:GUNOPAWIRO
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 COLONIAL RD
Mailing Address - Street 2:APT. R1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1952
Mailing Address - Country:US
Mailing Address - Phone:917-456-6059
Mailing Address - Fax:
Practice Address - Street 1:1824 MADISON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3832
Practice Address - Country:US
Practice Address - Phone:212-423-4200
Practice Address - Fax:646-770-8401
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400942-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health