Jaclyn Emma Sullivan, NP-C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

AG01190175 Issued in NJ

Practice address

466 Old Hook Rd Ste 1
Emerson, NJ 07630-1368

Phone

(201) 967-8221

Fax

(201) 967-0340

NPI assigned

Feb 3, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mrs. Jaclyn Emma Ulzheimer Former name

Medicare fee-for-service enrollment

Enrolled in NJ, NY2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MPV New Jersey MD Services PCGroup PAC ID 5991097669, 146 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Valley Hospital Hospital, Paramus, NJ, CCN 310012
• Hackensack Meridian Health Pascack Valley Medical Hospital, Westwood, NJ, CCN 310130

Merit-based Incentive Payment System (MIPS)

Final score

96.09 of 100Reported as apm

Quality

86.89

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

96.09 of 100Reported as apm

Quality

86.89

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: julzheimer1137474@ahs.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• MPV New Jersey MD Services PC

  • General Practice Physician
  • Westwood, NJ
  • NPI 1215391271
  Medicare reassignment Care Compare group
• Medical Associates of Englewood, PC

  • Internal Medicine Physician
  • Englewood, NJ
  • NPI 1952681918
  Medicare reassignment NPD
• Infinite Medical PC

  • Family Medicine Physician
  • Bristol, RI
  • NPI 1407483175

  NY

  Medicare reassignment NPD
• Optum Medical Care of New Jersey PC

  • Pediatrics Physician
  • New Hyde Park, NY
  • NPI 1578665048

  NJ

  Medicare reassignment NPD
• Optum Medical Care of New Jersey PC

  • Durable Medical Equipment & Medical Supplies
  • Belleville, NJ
  • NPI 1255050902
  NPD
• A.G. Dikengil, MD, PA

  • Radiology Clinic/Center
  • Lyndhurst, NJ
  • NPI 1205992690
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Pascack Valley Hospital LLC

  • General Acute Care Hospital
  • Westwood, NJ
  • NPI 1205176062
  Care Compare affiliation
• The Valley Hospital Inc.

  • General Acute Care Hospital
  • Paramus, NJ
  • NPI 1013912633
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786320000000",
    "number": "1730644873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 DEARBORN DR",
            "city": "OLD TAPPAN",
            "state": "NJ",
            "postal_code": "076757321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "466 OLD HOOK RD STE 1",
            "city": "EMERSON",
            "state": "NJ",
            "postal_code": "076301368",
            "telephone_number": "201-967-8221",
            "fax_number": "201-967-0340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JACLYN",
        "middle_name": "EMMA",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-03",
        "last_updated": "2026-08-10",
        "certification_date": "2026-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NJ",
            "license": "AG01190175",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NJ",
            "license": "AG01190175",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "ULZHEIMER",
            "middle_name": "EMMA",
            "prefix": "MRS.",
            "credential": "NP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Effie Sofos, DMD
• Philip A. Spagnesi, D.D.S.
• Speech Success
• Anat Spiero
• Strong Start Pediatric Therapy
• Timothy J Sullivan
• Summit Medical Group PA
• Peter Svider, MD
• Sylva A. Takvorian, M.D.
• Tsering Dolma Tamang, FNP

• Gerontology Nurse Practitioner in Emerson, NJ
• Providers in Emerson, NJ by specialty
• Gerontology Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.