Healthcare Provider Details

I. General information

NPI: 1255473666
Provider Name (Legal Business Name): EMMANISE LOUIS I FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMMANISE GREGOIRE FNP

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E MAIN ST STE 1
PORT JERVIS NY
12771-1924
US

IV. Provider business mailing address

88 COUTANT RD
CIRCLEVILLE NY
10919-3208
US

V. Phone/Fax

Practice location:
  • Phone: 845-893-9463
  • Fax: 845-767-5113
Mailing address:
  • Phone: 718-926-1264
  • Fax: 845-288-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332918-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: