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General NPI Number Information
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NPI Number | 1730828187
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Entity Type | Organization
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Legal Business Name | MARJORIE LOUIS-JACQUES NP FAMILY HEALTH PC
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 6144 ROUTE 25A STE 18B
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City | WADING RIVER
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State | NY
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Zip | 11792-2018
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Country | US
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Telephone | 732-239-0155
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Fax |
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Provider Business Mailing Address
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Address Line | 6144 ROUTE 25A STE 18B
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City | WADING RIVER
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State | NY
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Zip | 11792-2018
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MARJORIE LOUIS-JACQUES
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Credential | NP
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Telephone | 732-239-0115
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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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