MEDICARE: MIGUEL H JORGE

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	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1518579705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL H JORGE

Provider Business Mailing Address
First Line	:	307 MONROE ST STE 4-7
Second Line	:
City	:	PASSAIC
State	:	NJ
Zip	:	07055-5207
Country	:	US
Telephone Number	:	516-884-4940
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 125TH ST
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-1227
Country	:	US
Telephone Number	:	516-884-4940
Fax Number	:

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

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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