Healthcare Provider Details

I. General information

NPI: 1104647080
Provider Name (Legal Business Name): EILEEN XIE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 BROAD ST STE 606
NEWARK NJ
07102-4537
US

IV. Provider business mailing address

550 BROAD ST STE 606
NEWARK NJ
07102-4537
US

V. Phone/Fax

Practice location:
  • Phone: 866-994-5161
  • Fax: 877-485-8918
Mailing address:
  • Phone: 866-994-5161
  • Fax: 877-485-8918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15268700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP030619
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: