=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215256516
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACLYN M. HEUER NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2010
-----------------------------------------------------
Last Update Date | 06/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 466 OLD HOOK RD STE 1
-----------------------------------------------------
City | EMERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07630-1368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-967-8221
-----------------------------------------------------
Fax | 201-967-0340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 DEFOREST CT
-----------------------------------------------------
City | WEST NYACK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10994-1327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-558-4574
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 306237
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00712900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------