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General NPI Number Information
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NPI Number | 1518861046
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Entity Type | Individual
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Provider Name | JACQUELINE NAOMI ANNENBERG NP
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Gender |
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 635 MADISON AVE FL 10
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City | NEW YORK
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State | NY
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Zip | 10022-1009
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Country | US
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Telephone | 212-756-5777
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Fax |
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Provider Business Mailing Address
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Address Line | 14751 72ND AVE APT 2
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City | FLUSHING
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State | NY
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Zip | 11367-2543
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Country | US
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Telephone | 917-302-2844
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 422018
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License Number State | NY
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