Healthcare Provider Details

I. General information

NPI: 1548124480
Provider Name (Legal Business Name): JILL KANUI
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 HOLLAND AVE
BRONX NY
10467-8710
US

IV. Provider business mailing address

2750 HOLLAND AVE
BRONX NY
10467-8710
US

V. Phone/Fax

Practice location:
  • Phone: 347-884-6851
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN08466
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: