Provider Demographics
NPI:1134544372
Name:JEAN-JOSEPH, NIOLEDEN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:NIOLEDEN
Middle Name:
Last Name:JEAN-JOSEPH
Suffix:
Gender:
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-4837
Mailing Address - Country:US
Mailing Address - Phone:516-754-8487
Mailing Address - Fax:
Practice Address - Street 1:833 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-2836
Practice Address - Country:US
Practice Address - Phone:516-754-8487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2025-04-07
Deactivation Date:2024-07-04
Deactivation Code:
Reactivation Date:2024-09-03
Provider Licenses
StateLicense IDTaxonomies
NY679038163W00000X
NYF354503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse