Provider Demographics
NPI:1578182275
Name:MJ NP IN FAMILY HEALTH CARE P. C.
Entity Type:Organization
Organization Name:MJ NP IN FAMILY HEALTH CARE P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:631-394-5310
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-0273
Mailing Address - Country:US
Mailing Address - Phone:631-394-5310
Mailing Address - Fax:
Practice Address - Street 1:163 POOSPATUCK LN
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-5201
Practice Address - Country:US
Practice Address - Phone:631-394-5310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service