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General NPI Number Information
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NPI Number | 1821879867
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Entity Type | Individual
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Provider Name | JACQUELINE S PHILLIP
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Gender | Female
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 1915 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10303-2127
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Country | US
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Telephone | 718-981-3136
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Fax |
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Provider Business Mailing Address
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Address Line | 42 HANCOCK LN
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City | MANALAPAN
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State | NJ
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Zip | 07726-8911
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Country | US
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Telephone | 732-403-9107
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F405202-1
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License Number State | NY
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