Provider Demographics
NPI:1427343771
Name:SANON, JEAN PAUL (LPN)
Entity type:Individual
Prefix:MR
First Name:JEAN
Middle Name:PAUL
Last Name:SANON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13721 218TH ST
Mailing Address - Street 2:PH
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2228
Mailing Address - Country:US
Mailing Address - Phone:516-581-5591
Mailing Address - Fax:
Practice Address - Street 1:13721 218TH ST
Practice Address - Street 2:PH
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2228
Practice Address - Country:US
Practice Address - Phone:516-581-5591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY668095163W00000X
NY292613-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse