Healthcare Provider Details

I. General information

NPI: 1568308948
Provider Name (Legal Business Name): JACQUELINE LYNCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 AVENUE U
BROOKLYN NY
11223-5019
US

IV. Provider business mailing address

90 E 52ND ST
BROOKLYN NY
11203-1988
US

V. Phone/Fax

Practice location:
  • Phone: 718-717-8337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number356225
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: