1609598358 NPI number — WRJB NP FAMILY HEALTH PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609598358 NPI number — WRJB NP FAMILY HEALTH PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WRJB NP FAMILY HEALTH PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609598358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
228 E ROUTE 59 # 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NANUET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10954-2905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-362-8182
Provider Business Mailing Address Fax Number:
718-362-1651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 THE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ROCHELLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10801-2814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-362-1405
Provider Business Practice Location Address Fax Number:
718-414-1651
Provider Enumeration Date:
09/19/2022

Additional Information

Authorized Official

Authorized Official Last Name:
JEAN-BAPTISTE
Authorized Official First Name:
WATSON
Authorized Official Middle Name:
Authorized Official Title or Position:
FNP/OWNER
Authorized Official Telephone Number:
718-362-8182

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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