Provider Demographics
NPI:1649242744
Name:BEANE, JOCELYN C (MD)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:C
Last Name:BEANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:C
Other - Last Name:AZNAR-BEANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:214 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1295
Mailing Address - Country:US
Mailing Address - Phone:315-493-0128
Mailing Address - Fax:315-493-6200
Practice Address - Street 1:214 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1212
Practice Address - Country:US
Practice Address - Phone:315-493-0128
Practice Address - Fax:315-493-6200
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00896951Medicaid
NY162522OtherSTATE LICENSE NUMBER
NYAB3256888OtherDEA NUMBER
NY162522OtherSTATE LICENSE NUMBER
NYCC4677Medicare ID - Type Unspecified