Healthcare Provider Details

I. General information

NPI: 1184536393
Provider Name (Legal Business Name): JELENA RAMOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JELENA MEDOJEVIC

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 SAINT NICHOLAS AVE # B
RIDGEWOOD NY
11385-2296
US

IV. Provider business mailing address

311 SAINT NICHOLAS AVE # B
RIDGEWOOD NY
11385-2296
US

V. Phone/Fax

Practice location:
  • Phone: 718-766-5150
  • Fax: 516-331-5555
Mailing address:
  • Phone: 718-766-5150
  • Fax: 516-331-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number312888
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: