MEDICARE: JAZMAN MONA IFILL

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	101YM0800X	Mental Health Counselor		NY

General Provider Information

NPI Number	:	1063188498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZMAN MONA IFILL

Provider Business Mailing Address
First Line	:	2896 SHELL RD STE 501
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3609
Country	:	US
Telephone Number	:	929-833-8993
Fax Number	:

Provider Business Practice Location Address
First Line	:	2896 SHELL RD STE 501
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3609
Country	:	US
Telephone Number	:	929-833-8993
Fax Number	:

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

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	03/25/2026

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