Individual
BEENA JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 MINEOLA BLVD FL 2, MINEOLA, NY 11501-4089
(516) 663-3511
Mailing address
285 E MAIN ST STE 105, SMITHTOWN, NY 11787-2912
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F307794-1
NY
Other
Enumeration date
05/05/2017
Last updated
03/19/2021
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