Provider Demographics
NPI:1053768507
Name:CYPRIEN, JEAN MAX SR
Entity type:Individual
Prefix:MR
First Name:JEAN MAX
Middle Name:
Last Name:CYPRIEN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 W FUNSTON AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5569
Mailing Address - Country:US
Mailing Address - Phone:845-300-3533
Mailing Address - Fax:
Practice Address - Street 1:20 OLD TURNPIKE RD STE 307
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2530
Practice Address - Country:US
Practice Address - Phone:845-624-0260
Practice Address - Fax:845-624-0264
Is Sole Proprietor?:No
Enumeration Date:2016-05-14
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305596-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse