Healthcare Provider Details

I. General information

NPI: 1083332035
Provider Name (Legal Business Name): JESSENIA KARINA CALLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E 76TH ST OFC 1A
NEW YORK NY
10021-2833
US

IV. Provider business mailing address

80 PINEWOOD RD APT 1B
HARTSDALE NY
10530-1638
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-4130
  • Fax:
Mailing address:
  • Phone: 347-278-3987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number350161
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: