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General NPI Number Information
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NPI Number | 1407224421
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Entity Type | Organization
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Legal Business Name | EAST JEFFERSON FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 09/08/2015
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 3848 VETERANS MEMORIAL BLVD SUITE 202
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City | METAIRIE
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State | LA
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Zip | 70002
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Country | US
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Telephone | 225-205-7060
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Fax | 504-885-2510
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Provider Business Mailing Address
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Address Line | 3848 VETERANS MEMORIAL BLVD STE 101
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City | METAIRIE
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State | LA
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Zip | 70002-5636
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Country | US
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Telephone | 504-885-2505
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Fax | 504-885-2510
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | AMANI ISMAIL
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Credential |
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Telephone | 504-885-2505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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