MEDICARE: JOCELYNE LABOG JENKINS

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	225200000X	Physical Therapy Assistant	010740-1	NY
2	225100000X	Physical Therapist	045624-01	NY

General Provider Information

NPI Number	:	1043702913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOCELYNE LABOG JENKINS

Provider Business Mailing Address
First Line	:	3104 WILKINSON AVE APT 3E
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-4687
Country	:	US
Telephone Number	:	702-908-5965
Fax Number	:

Provider Business Practice Location Address
First Line	:	3104 WILKINSON AVE APT 3E
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-4687
Country	:	US
Telephone Number	:	702-908-5965
Fax Number	:

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

Provider Enumeration Date	:	06/05/2018
Last Update Date	:	05/26/2020

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