Healthcare Provider Details

I. General information

NPI: 1831088020
Provider Name (Legal Business Name): JESSE CIFUNI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

IV. Provider business mailing address

14 ASPEN CT
NANUET NY
10954-3815
US

V. Phone/Fax

Practice location:
  • Phone: 732-339-7630
  • Fax:
Mailing address:
  • Phone: 845-721-4769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number26NR24956100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: