MEDICARE: DR. JEWEL PETERGAY JONES M.D.

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	207P00000X	Emergency Medicine Physician	263167-1	NY

General Provider Information

NPI Number	:	1285897579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEWEL PETERGAY JONES M.D.

Provider Business Mailing Address
First Line	:	483 48TH AVE
Second Line	:	#3B
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5538
Country	:	US
Telephone Number	:	917-495-9829
Fax Number	:

Provider Business Practice Location Address
First Line	:	483 48TH AVE
Second Line	:	#3B
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5538
Country	:	US
Telephone Number	:	917-495-9829
Fax Number	:

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

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	12/01/2011

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