Provider Demographics
NPI:1265780233
Name:BARONE, MEDINA ELIZABETH (ANP)
Entity type:Individual
Prefix:MISS
First Name:MEDINA
Middle Name:ELIZABETH
Last Name:BARONE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15330 89TH AVE
Mailing Address - Street 2:SUITE 1206
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3821
Mailing Address - Country:US
Mailing Address - Phone:917-569-3844
Mailing Address - Fax:
Practice Address - Street 1:355 GRAND ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4321
Practice Address - Country:US
Practice Address - Phone:201-915-2000
Practice Address - Fax:732-923-2272
Is Sole Proprietor?:No
Enumeration Date:2012-08-24
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5683211363LA2200X
NJ26NJ01434900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health