Provider Demographics
NPI:1144899980
Name:EL-MINIAWI, JESSICA NASSER
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:NASSER
Last Name:EL-MINIAWI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 KEEN GATE
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6217
Mailing Address - Country:US
Mailing Address - Phone:516-884-5558
Mailing Address - Fax:
Practice Address - Street 1:2 KEEN GATE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-6217
Practice Address - Country:US
Practice Address - Phone:516-884-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist