Provider Demographics
NPI:1699326009
Name:JEON, HYERIM (NP)
Entity type:Individual
Prefix:
First Name:HYERIM
Middle Name:
Last Name:JEON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6542
Mailing Address - Country:US
Mailing Address - Phone:332-215-3002
Mailing Address - Fax:212-824-2330
Practice Address - Street 1:1470 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6542
Practice Address - Country:US
Practice Address - Phone:212-824-8579
Practice Address - Fax:212-824-2330
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345095363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY345095OtherNURSE PRACTITIONER IN FAMILY HEALTH LICENSE