Provider Demographics
NPI:1265891485
Name:MCQUEEN KING, ENJOLI (CRNP)
Entity type:Individual
Prefix:
First Name:ENJOLI
Middle Name:
Last Name:MCQUEEN KING
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MADISON AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2400
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:1167 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5417
Practice Address - Country:US
Practice Address - Phone:718-778-0198
Practice Address - Fax:718-221-8169
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-134290363LG0600X, 363LW0102X
NYF308023-1363LA2200X
NYF421268-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
WI331954Medicare Oscar/Certification
WI331957Medicare Oscar/Certification
NY00695941Medicaid
WI331947Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
WI331944Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
WI331009Medicare Oscar/Certification
WI331043Medicare Oscar/Certification
WI331945Medicare Oscar/Certification
WI331943Medicare Oscar/Certification
WI331952Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
WI331058Medicare Oscar/Certification