Provider Demographics
NPI:1437284551
Name:DELALEU, JENNY (RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:DELALEU
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:DELALEU-MCINTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP-BC
Mailing Address - Street 1:294 W MERRICK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3357
Mailing Address - Country:US
Mailing Address - Phone:516-279-5484
Mailing Address - Fax:516-589-7569
Practice Address - Street 1:294 W MERRICK RD
Practice Address - Street 2:SUITE 6
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3374
Practice Address - Country:US
Practice Address - Phone:516-279-5484
Practice Address - Fax:516-589-7569
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03415092Medicaid
NY03415092Medicaid