Individual
JACQUELYN S STATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 E 77TH ST, NEW YORK, NY 10075-1850
(212) 434-2000
Mailing address
100 E 77TH ST, NEW YORK, NY 10075-1850
(212) 434-2000
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
26NJ00814500
NJ
Other
Enumeration date
01/03/2019
Last updated
10/23/2023
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