Healthcare Provider Details

I. General information

NPI: 1760033294
Provider Name (Legal Business Name): JACQUELINE CONNERY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

560 1ST AVE # 11EAST
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

55 HOPE ST APT 214
BROOKLYN NY
11211-4865
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7000
  • Fax:
Mailing address:
  • Phone: 914-629-1431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF309271-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: