Provider Demographics
NPI:1366757411
Name:MCINTYRE, JANICE E (ANP)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:E
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 LAUREL TRAIL
Mailing Address - Street 2:PO BOX 542
Mailing Address - City:LAUREL
Mailing Address - State:NY
Mailing Address - Zip Code:11948
Mailing Address - Country:US
Mailing Address - Phone:631-298-2050
Mailing Address - Fax:
Practice Address - Street 1:2 UNION AVE
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3324
Practice Address - Country:US
Practice Address - Phone:631-878-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30-305508363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health