Healthcare Provider Details

I. General information

NPI: 1073602215
Provider Name (Legal Business Name): JACQUELINE ELEANOR JONES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 PARK AVENUE SUITE 1A
NEW YORK NY
10128-1211
US

IV. Provider business mailing address

1175 PARK AVENUE SUITE 1A
NEW YORK NY
10128-1211
US

V. Phone/Fax

Practice location:
  • Phone: 212-996-2559
  • Fax: 212-996-2703
Mailing address:
  • Phone: 212-996-2559
  • Fax: 212-996-2703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number182047
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: