Healthcare Provider Details

I. General information

NPI: 1164073664
Provider Name (Legal Business Name): JENNIFER NIELSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

6 BROOKWOOD RD
STANHOPE NJ
07874-3220
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5800
  • Fax:
Mailing address:
  • Phone: 908-578-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number762083
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: