Provider Demographics
NPI:1649516592
Name:BEATTY, MARI JANET (PA-C)
Entity type:Individual
Prefix:MS
First Name:MARI
Middle Name:JANET
Last Name:BEATTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MARI
Other - Middle Name:JANET
Other - Last Name:KAWAMURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E 77TH ST
Mailing Address - Street 2:2ND FLOOR - DEPT OF GASTROENTEROLOGY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1850
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 E 77TH ST
Practice Address - Street 2:2ND FLOOR - DEPT OF GASTROENTEROLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1850
Practice Address - Country:US
Practice Address - Phone:212-434-6279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016180363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical