Healthcare Provider Details

I. General information

NPI: 1265891485
Provider Name (Legal Business Name): ENJOLI MCQUEEN KING CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 NOSTRAND AVE
BROOKLYN NY
11225-5417
US

IV. Provider business mailing address

60 MADISON AVE 5TH FLOOR
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 718-778-0198
  • Fax: 718-221-8169
Mailing address:
  • Phone: 212-545-2400
  • Fax: 646-312-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-134290
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1-134290
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF308023-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF421268-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: