Healthcare Provider Details

I. General information

NPI: 1255582599
Provider Name (Legal Business Name): DJENANE BARTHOLOMEW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DJENANE THIBAUT RN

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 53RD ST
BROOKLYN NY
11220-2736
US

IV. Provider business mailing address

23 DORA LN
HOLMDEL NJ
07733-1624
US

V. Phone/Fax

Practice location:
  • Phone: 516-852-2463
  • Fax:
Mailing address:
  • Phone: 732-888-1355
  • Fax: 732-888-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number523142-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF310460-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number26NR13685400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: