Provider Demographics
NPI:1023675881
Name:RINGHISEN, JOHN JUSTIN (PMHNP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JUSTIN
Last Name:RINGHISEN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HARRISON ST APT 803
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3003
Mailing Address - Country:US
Mailing Address - Phone:336-708-8198
Mailing Address - Fax:
Practice Address - Street 1:500 HARRISON ST APT 803
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3003
Practice Address - Country:US
Practice Address - Phone:336-708-8198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402630363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health