Provider Demographics
NPI:1730165192
Name:GAETAN, JUAN (CPNP-PC)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:GAETAN
Suffix:
Gender:M
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2094 PITKIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-3509
Mailing Address - Country:US
Mailing Address - Phone:718-240-0400
Mailing Address - Fax:
Practice Address - Street 1:82-68 164TH ST.
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1121
Practice Address - Country:US
Practice Address - Phone:718-883-3075
Practice Address - Fax:718-883-6115
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY466314163W00000X
NYF381315363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02267756Medicaid
NY02267756Medicaid
NYQ10699Medicare UPIN