Healthcare Provider Details

I. General information

NPI: 1750242020
Provider Name (Legal Business Name): GREENLEAF NURSE PRACTITIONER IN PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 SOUTH AVE STE 100
STATEN ISLAND NY
10314-3411
US

IV. Provider business mailing address

46 LAKE PARK DR
PISCATAWAY NJ
08854-5171
US

V. Phone/Fax

Practice location:
  • Phone: 646-796-4676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IJEAMAKA EMEJURU
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 646-796-4676