Healthcare Provider Details

I. General information

NPI: 1699382242
Provider Name (Legal Business Name): EMEE M. ENRIQUEZ APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BERGEN ST
NEWARK NJ
07103-2496
US

IV. Provider business mailing address

150 BERGEN ST
NEWARK NJ
07103-2496
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ01084500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: