Healthcare Provider Details

I. General information

NPI: 1073424776
Provider Name (Legal Business Name): JAIME MORRIS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 PARKWAY DR
WEST NYACK NY
10994-2113
US

IV. Provider business mailing address

16 PARKWAY DR
WEST NYACK NY
10994-2113
US

V. Phone/Fax

Practice location:
  • Phone: 845-521-4700
  • Fax:
Mailing address:
  • Phone: 845-521-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360889
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: