Individual
JIYOUNG BACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
26 GREENVILLE AVE, JERSEY CITY, NJ 07305
(201) 333-8222
(201) 333-9500
Mailing address
26 GREENVILLE AVE, JERSEY CITY, NJ 07305-2608
(201) 333-8222
(201) 333-9500
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
338354
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0595624
—
NJ
Enumeration date
06/27/2014
Last updated
03/25/2021
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