Basic Information
Provider Information
NPI: 1427327345
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FORBES
FirstName: JHENELLE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 68 S SERVICE RD
Address2: SUITE 350
City: MELVILLE
State: NY
PostalCode: 117472354
CountryCode: US
TelephoneNumber: 5169453000
FaxNumber: 5169453131
Practice Location
Address1: 95 GRASSLANDS RD
Address2:  
City: VALHALLA
State: NY
PostalCode: 105951652
CountryCode: US
TelephoneNumber: 9144937857
FaxNumber: 9144938439
Other Information
ProviderEnumerationDate: 12/21/2011
LastUpdateDate: 07/23/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X560018NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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