=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275407900
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN MAE P ENRIQUEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2025
-----------------------------------------------------
Last Update Date | 10/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 263 GRAND ST
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07302-4317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-992-8290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 DRAKE RD
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-2363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-789-0370
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ15414100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------