Provider Demographics
NPI:1861572901
Name:CHIDEKEL, JANE HEALY (FNP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:HEALY
Last Name:CHIDEKEL
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 1:50 FORT PL
Mailing Address - Street 2:APT. A2D
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2415
Mailing Address - Country:US
Mailing Address - Phone:718-816-7766
Mailing Address - Fax:
Practice Address - Street 1:150 ESSEX ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-2301
Practice Address - Country:US
Practice Address - Phone:212-477-1120
Practice Address - Fax:212-477-8957
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332582-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331978Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NY00695941Medicaid