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General NPI Number Information
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NPI Number | 1902265192
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Entity Type | Organization
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Legal Business Name | NADJA LOUIS JACQUES NP PC
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 1368 NOSTRAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11226-2503
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Country | US
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Telephone | 516-782-6728
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Fax |
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Provider Business Mailing Address
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Address Line | 319 SOUTHWOOD CIR
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City | SYOSSET
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State | NY
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Zip | 11791-5715
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Country | US
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Telephone | 516-782-6728
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Fax |
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Authorized Official
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Title or Position | STAFF PHYSICIAN
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Name | NADJA LOUIS JAQUES
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Credential |
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Telephone | 516-782-6728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F336938
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License Number State | NY
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