Healthcare Provider Details

I. General information

NPI: 1407224421
Provider Name (Legal Business Name): EAST JEFFERSON FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 09/02/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3848 VETERANS MEMORIAL BLVD SUITE 202
METAIRIE LA
70002
US

IV. Provider business mailing address

3848 VETERANS MEMORIAL BLVD STE 101
METAIRIE LA
70002-5636
US

V. Phone/Fax

Practice location:
  • Phone: 225-205-7060
  • Fax: 504-885-2510
Mailing address:
  • Phone: 504-885-2505
  • Fax: 504-885-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANI ISMAIL
Title or Position: GENERAL MANAGER
Credential:
Phone: 504-885-2505