Healthcare Provider Details

I. General information

NPI: 1588454094
Provider Name (Legal Business Name): JIJI GEORGE NURSE PRACTITIONER IN PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 N 5TH ST
NEW HYDE PARK NY
11040-2929
US

IV. Provider business mailing address

536 N 5TH ST
NEW HYDE PARK NY
11040-2929
US

V. Phone/Fax

Practice location:
  • Phone: 516-444-1229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JIJI GEORGE
Title or Position: CEO & PRESIDENT
Credential:
Phone: 516-444-1229