MEDICARE: HAUTESIDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1871422063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAUTESIDE

Provider Business Mailing Address
First Line	:	831-835 S 15TH ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07108-1393
Country	:	US
Telephone Number	:	908-392-6058
Fax Number	:

Provider Business Practice Location Address
First Line	:	831-835 S 15TH ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07108-1393
Country	:	US
Telephone Number	:	908-392-6058
Fax Number	:

Authorized Official
Title or Position	:	APN
Name	:	JOUDLIE JEAN
Credential	:
Telephone Number	:	908-392-6058

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/14/2026

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Directions to “HAUTESIDE ” Practice Location

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