Healthcare Provider Details

I. General information

NPI: 1982933784
Provider Name (Legal Business Name): BIJOU KADIMA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 BURRSTONE RD
UTICA NY
13502-4857
US

IV. Provider business mailing address

2079 FOREST AVE
STATEN ISLAND NY
10303-1865
US

V. Phone/Fax

Practice location:
  • Phone: 732-630-1586
  • Fax:
Mailing address:
  • Phone: 718-815-6560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number622286
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number350028
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF350028-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: