Healthcare Provider Details

I. General information

NPI: 1922651231
Provider Name (Legal Business Name): JENNIFER GILLIGAN RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W 40TH ST
NEW YORK NY
10018-3617
US

IV. Provider business mailing address

104 W 40TH ST
NEW YORK NY
10018-3617
US

V. Phone/Fax

Practice location:
  • Phone: 646-930-4147
  • Fax:
Mailing address:
  • Phone: 646-930-4147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number518774
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404992
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: