Provider Demographics
NPI:1578953501
Name:JENNY DELALEU NURSE PRACTITIONER IN FAMILY HEALTH PLLC
Entity Type:Organization
Organization Name:JENNY DELALEU NURSE PRACTITIONER IN FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELALEU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:516-279-5484
Mailing Address - Street 1:53 E MERRICK RD
Mailing Address - Street 2:#134
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-4056
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:#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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334623174H00000X, 207Q00000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1437284551OtherNPI