Provider Demographics
NPI:1699063495
Name:PROMNITZ, MEGHAN MJ (FNP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:MJ
Last Name:PROMNITZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:MJ
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:19 WEST AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6049
Mailing Address - Country:US
Mailing Address - Phone:518-583-0111
Mailing Address - Fax:518-583-2426
Practice Address - Street 1:19 WEST AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6049
Practice Address - Country:US
Practice Address - Phone:518-583-0111
Practice Address - Fax:518-583-2426
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02995513Medicaid
NY03388736Medicaid
NY03388736Medicaid
NY331833Medicare Oscar/Certification