Provider Demographics
NPI:1659846889
Name:JEAN MICHEL, CARYNE (CM)
Entity Type:Individual
Prefix:
First Name:CARYNE
Middle Name:
Last Name:JEAN MICHEL
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1847 SHORE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6619
Mailing Address - Country:US
Mailing Address - Phone:347-546-0360
Mailing Address - Fax:
Practice Address - Street 1:1847 SHORE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6619
Practice Address - Country:US
Practice Address - Phone:347-546-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-30454174N00000X
NY001971176B00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5979153Medicaid