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General NPI Number Information
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NPI Number | 1407158470
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Entity Type | Organization
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Legal Business Name | JLP MEDICINE, PC
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Dates
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Enumeration Date | 11/24/2010
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Last Update Date | 11/24/2010
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Provider Practice Location Address
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Address Line | 2035 RALPH AVE SUITE A-4
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City | BROOKLYN
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State | NY
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Zip | 11234-5300
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Country | US
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Telephone | 732-306-4935
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Fax | 732-238-7115
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Provider Business Mailing Address
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Address Line | 10 TIMOTHY LN
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-4560
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Country | US
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Telephone | 732-306-4935
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Fax | 732-238-7115
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Authorized Official
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Title or Position | PRESIDENT
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Name | JODI PESKA MOSSERI
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Credential | D.O.
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Telephone | 732-306-4935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 257892
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License Number State | NY
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