Healthcare Provider Details

I. General information

NPI: 1578953501
Provider Name (Legal Business Name): JENNY DELALEU NURSE PRACTITIONER IN FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 W MERRICK RD STE 1
FREEPORT NY
11520-3357
US

IV. Provider business mailing address

53 E MERRICK RD #134
FREEPORT NY
11520-4056
US

V. Phone/Fax

Practice location:
  • Phone: 516-279-5484
  • Fax: 516-589-7569
Mailing address:
  • Phone: 516-279-5484
  • Fax: 516-589-7569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberF334623
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF334623
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberF334623
License Number StateNY

VIII. Authorized Official

Name: JENNY DELALEU
Title or Position: OWNER
Credential:
Phone: 516-279-5484