MEDICARE: JEROME LUCENA AMANQUITON

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	225100000X	Physical Therapist	029755	NY

General Provider Information

NPI Number	:	1295922565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME LUCENA AMANQUITON

Provider Business Mailing Address
First Line	:	8810 34TH AVE APT 2H
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-3418
Country	:	US
Telephone Number	:	347-285-7701
Fax Number	:

Provider Business Practice Location Address
First Line	:	8810 34TH AVE APT 2H
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-3418
Country	:	US
Telephone Number	:	347-285-7701
Fax Number	:

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

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	02/05/2025

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