Healthcare Provider Details

I. General information

NPI: 1063238939
Provider Name (Legal Business Name): ESTEFANY CACERES JIMENEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 PARK AVE STE 6A
PLAINFIELD NJ
07060-3015
US

IV. Provider business mailing address

350 MADISON GDNS
OLD BRIDGE NJ
08857-2820
US

V. Phone/Fax

Practice location:
  • Phone: 908-222-8400
  • Fax:
Mailing address:
  • Phone: 848-466-5799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15201000
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: