Provider Demographics
NPI:1841735248
Name:AGNANT, REGINE
Entity Type:Individual
Prefix:
First Name:REGINE
Middle Name:
Last Name:AGNANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REGINE
Other - Middle Name:
Other - Last Name:JEAN-PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99 CLENT RD
Mailing Address - Street 2:B102
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4900
Mailing Address - Country:US
Mailing Address - Phone:914-646-6500
Mailing Address - Fax:
Practice Address - Street 1:110 E 59TH ST
Practice Address - Street 2:8TH FLOOR SUITE 8B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1304
Practice Address - Country:US
Practice Address - Phone:212-734-1353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341067-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily