MEDICARE: JACQUELINE ELEANOR JONES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YP0228X	Pediatric Otolaryngology Physician	182047	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	182047	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1073602215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE ELEANOR JONES MD

Provider Business Mailing Address
First Line	:	1175 PARK AVENUE
Second Line	:	SUITE 1A
City	:	NEW YORK
State	:	NY
Zip	:	10128-1211
Country	:	US
Telephone Number	:	212-996-2559
Fax Number	:	212-996-2703

Provider Business Practice Location Address
First Line	:	1175 PARK AVENUE
Second Line	:	SUITE 1A
City	:	NEW YORK
State	:	NY
Zip	:	10128-1211
Country	:	US
Telephone Number	:	212-996-2559
Fax Number	:	212-996-2703

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/16/2012

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