Provider Demographics
NPI:1710931753
Name:JANSSEN, ELIZABETH FELLOWS (MA, APRN,BC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:FELLOWS
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:MA, APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 HUXLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1903
Mailing Address - Country:US
Mailing Address - Phone:646-226-2967
Mailing Address - Fax:
Practice Address - Street 1:228 E 45TH ST
Practice Address - Street 2:1801
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3303
Practice Address - Country:US
Practice Address - Phone:212-661-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319554163WP0809X
NYF400208363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2887649OtherOXFORD ID