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General NPI Number Information
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NPI Number | 1306644703
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Entity Type | Organization
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Legal Business Name | MJT NP IN FAMILY HEALTH PLLC
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 87 BENSON ST APT 3
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City | W HAVERSTRAW
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State | NY
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Zip | 10993-1340
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Country | US
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Telephone | 833-221-4769
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Fax |
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Provider Business Mailing Address
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Address Line | 45 S ROUTE 9W STE 41
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City | WEST HAVERSTRAW
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State | NY
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Zip | 10993-1053
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Country | US
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Telephone | 845-996-3320
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAXIME TOUSSAINT
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Credential |
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Telephone | 833-221-4169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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