Provider Demographics
NPI:1588102727
Name:NADJA LOUISJACQUES, NP IN FAMILY HEALTH P.C.
Entity type:Organization
Organization Name:NADJA LOUISJACQUES, NP IN FAMILY HEALTH P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:NADJA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUIS-JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:516-782-6728
Mailing Address - Street 1:319 SOUTHWOOD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:718-778-0937
Mailing Address - Fax:718-776-0933
Practice Address - Street 1:1210 NOSTRAND AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225
Practice Address - Country:US
Practice Address - Phone:718-778-0937
Practice Address - Fax:718-778-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 208000000X, 363L00000X
NY336938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02679972Medicaid