Provider Demographics
NPI:1013568153
Name:BETANCOURT, JAIME LUIS (DNP, MPH, APN)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:LUIS
Last Name:BETANCOURT
Suffix:
Gender:M
Credentials:DNP, MPH, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PATERSON PLANK RD # 31043
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-3416
Mailing Address - Country:US
Mailing Address - Phone:732-491-1875
Mailing Address - Fax:
Practice Address - Street 1:138 W 25TH ST FL 11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7405
Practice Address - Country:US
Practice Address - Phone:646-926-5758
Practice Address - Fax:646-775-4142
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344643363LF0000X
NJ26NJ01039400363LF0000X, 363LP0808X
NY407386363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily