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Individual

MR. JUAN GAETAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CPNP-PC

Contact information

Practice address
82-68 164TH ST., DEPARTMENT OF EMERGENCY MEDICINE, JAMAICA, NY 11432-1121
(718) 883-3075
(718) 883-6115
Mailing address
2094 PITKIN AVE, BROOKLYN, NY 11207-3509
(718) 240-0400

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
466314
NY
363LP0200X
Pediatric Nurse Practitioner
Primary
F381315
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02267756
NY
Enumeration date
12/19/2005
Last updated
05/30/2024
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