Provider Demographics
NPI:1962692244
Name:BRYANT, JANINE MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:MARIE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BROOK PL
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-1001
Mailing Address - Country:US
Mailing Address - Phone:631-859-0270
Mailing Address - Fax:
Practice Address - Street 1:4 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:SPEONK
Practice Address - State:NY
Practice Address - Zip Code:11972
Practice Address - Country:US
Practice Address - Phone:631-325-8654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY372018-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02043254Medicaid