MEDICARE: DR. MICHELLE AHN JEONG

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	183500000X	Pharmacist	058692	NY

General Provider Information

NPI Number	:	1285064675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE AHN JEONG

Provider Business Mailing Address
First Line	:	50 FOREST DR
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-2308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 FOREST DR
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-2308
Country	:	US
Telephone Number	:	516-932-0551
Fax Number	:

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

Provider Enumeration Date	:	11/20/2013
Last Update Date	:	11/20/2013

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Directions to “ DR. MICHELLE AHN JEONG ” Practice Location

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