MEDICARE: JENNY DELALEU NURSE PRACTITIONER IN FAMILY HEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center	F334623	NY
2	174H00000X	Health Educator	F334623	NY
3	207Q00000X	Family Medicine Physician	F334623	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1437284551	OTHER	NY	NPI

General Provider Information

NPI Number	:	1578953501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNY DELALEU NURSE PRACTITIONER IN FAMILY HEALTH PLLC

Provider Business Mailing Address
First Line	:	53 E MERRICK RD
Second Line	:	#134
City	:	FREEPORT
State	:	NY
Zip	:	11520-4056
Country	:	US
Telephone Number	:	516-279-5484
Fax Number	:	516-589-7569

Provider Business Practice Location Address
First Line	:	294 W MERRICK RD STE 1
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-3357
Country	:	US
Telephone Number	:	516-279-5484
Fax Number	:	516-589-7569

Authorized Official
Title or Position	:	OWNER
Name	:	JENNY DELALEU
Credential	:
Telephone Number	:	516-279-5484

Provider Enumeration Date	:	01/29/2015
Last Update Date	:	05/31/2024

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