Healthcare Provider Details

I. General information

NPI: 1215256516
Provider Name (Legal Business Name): JACLYN M. HEUER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 OLD HOOK RD STE 1
EMERSON NJ
07630-1368
US

IV. Provider business mailing address

3 DEFOREST CT
WEST NYACK NY
10994-1327
US

V. Phone/Fax

Practice location:
  • Phone: 201-967-8221
  • Fax: 201-967-0340
Mailing address:
  • Phone: 845-558-4574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number306237
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00712900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: