Healthcare Provider Details

I. General information

NPI: 1215153572
Provider Name (Legal Business Name): JENNEFIE MARILYN JOHN RESPIRATORY THERAPIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2057
US

IV. Provider business mailing address

25516 148TH RD
ROSEDALE NY
11422-2808
US

V. Phone/Fax

Practice location:
  • Phone: 178-245-4526
  • Fax:
Mailing address:
  • Phone: 347-548-4795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279P3800X
TaxonomyPalliative/Hospice Registered Respiratory Therapist
License Number005997-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number005997-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2279E0002X
TaxonomyEmergency Care Registered Respiratory Therapist
License Number005997-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number005997-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License Number005997-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number005997-1
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code2279S1500X
TaxonomySNF/Subacute Care Registered Respiratory Therapist
License Number005997-1
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code2279P1004X
TaxonomyPulmonary Diagnostics Registered Respiratory Therapist
License Number005997-1
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code2279P1006X
TaxonomyPulmonary Function Technologist Registered Respiratory Therapist
License Number005997-1
License Number StateNY
# 10
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number005997-1
License Number StateNY
# 11
Primary TaxonomyY
Taxonomy Code2279E1000X
TaxonomyEducational Registered Respiratory Therapist
License Number005997-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: