Provider Demographics
NPI:1588080139
Name:CHAIYASIT, JANEJIRA (AGNP)
Entity type:Individual
Prefix:
First Name:JANEJIRA
Middle Name:
Last Name:CHAIYASIT
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W 168TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4103
Mailing Address - Country:US
Mailing Address - Phone:212-326-5705
Mailing Address - Fax:212-342-0093
Practice Address - Street 1:516 W 168TH ST FL 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4103
Practice Address - Country:US
Practice Address - Phone:212-326-5705
Practice Address - Fax:212-342-0093
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 678653163W00000X
NY30 307174363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse