Provider Demographics
NPI:1346794971
Name:JUBILEE, JEFFREY GRANT (NP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:GRANT
Last Name:JUBILEE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 44TH DR
Mailing Address - Street 2:APT 1G
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4749
Mailing Address - Country:US
Mailing Address - Phone:212-810-1193
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6504
Practice Address - Country:US
Practice Address - Phone:212-241-5342
Practice Address - Fax:212-860-7419
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307811363LA2200X
NY431469363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health