Provider Demographics
NPI:1912453283
Name:JEAN-PHILIPPE, SOPHONIE (LPN)
Entity Type:Individual
Prefix:
First Name:SOPHONIE
Middle Name:
Last Name:JEAN-PHILIPPE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 BROADWAY
Mailing Address - Street 2:APT. 5H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-7610
Mailing Address - Country:US
Mailing Address - Phone:718-313-7676
Mailing Address - Fax:
Practice Address - Street 1:5210 BROADWAY
Practice Address - Street 2:5H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:728-313-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324132-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse