Healthcare Provider Details

I. General information

NPI: 1306644703
Provider Name (Legal Business Name): MJT NP IN FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 BENSON ST APT 3
W HAVERSTRAW NY
10993-1340
US

IV. Provider business mailing address

45 S ROUTE 9W STE 41
WEST HAVERSTRAW NY
10993-1053
US

V. Phone/Fax

Practice location:
  • Phone: 833-221-4769
  • Fax:
Mailing address:
  • Phone: 845-996-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MAXIME TOUSSAINT
Title or Position: PRESIDENT
Credential:
Phone: 833-221-4169