Provider Demographics
NPI:1881969251
Name:PAINSON, JEAN LUTHER (NP)
Entity type:Individual
Prefix:MR
First Name:JEAN
Middle Name:LUTHER
Last Name:PAINSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 E 81ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4222
Mailing Address - Country:US
Mailing Address - Phone:718-812-0236
Mailing Address - Fax:
Practice Address - Street 1:1016 E 81ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4222
Practice Address - Country:US
Practice Address - Phone:717-716-7107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-18
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401460363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03621116Medicaid
401460OtherNURSE PRACTITIONER LICENSE