Healthcare Provider Details

I. General information

NPI: 1467161406
Provider Name (Legal Business Name): VERNON JENKINS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: VERNON JENKINS LMT

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16129 JEWEL AVE
FRESH MEADOWS NY
11365-4352
US

IV. Provider business mailing address

16129 JEWEL AVE
FRESH MEADOWS NY
11365-4352
US

V. Phone/Fax

Practice location:
  • Phone: 718-300-2751
  • Fax:
Mailing address:
  • Phone: 718-300-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number028276
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007645
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: