Provider Demographics
NPI:1669859096
Name:MEISEL, JASON (PMHNP-BC, RN-BC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:MEISEL
Suffix:
Gender:M
Credentials:PMHNP-BC, RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 PRESIDENT ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1186
Mailing Address - Country:US
Mailing Address - Phone:740-777-6184
Mailing Address - Fax:206-309-3725
Practice Address - Street 1:641 PRESIDENT ST STE 201
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1186
Practice Address - Country:US
Practice Address - Phone:740-777-6184
Practice Address - Fax:206-309-3725
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY612103163W00000X
NYF401965363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2016002199OtherPMHNP LICENSE