Provider Demographics
NPI:1245861954
Name:GJECI, TAIJA LYNN (FNP)
Entity type:Individual
Prefix:
First Name:TAIJA
Middle Name:LYNN
Last Name:GJECI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HOMESTEAD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-4211
Mailing Address - Country:US
Mailing Address - Phone:914-263-2386
Mailing Address - Fax:
Practice Address - Street 1:3 SAINT STEPHENS PL STE 3
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-3210
Practice Address - Country:US
Practice Address - Phone:845-987-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily